Medicaid eligibility screener

General guidance only. Medicaid rules vary significantly by state and change periodically. This tool provides general guidance for discussion with an elder law attorney - it doesn't replace tailored legal advice or an actual Medicaid application. See our full disclaimer.

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An elder law attorney confirms your state's exact asset and income limits, identifies legitimate planning strategies for your timeline, and helps navigate the application process to avoid costly mistakes. Free initial consultation in most areas.

Why is Medicaid planning different from other estate planning?

Medicaid is a means-tested program with strict asset and income limits - for long-term care Medicaid specifically, an individual applicant typically must have countable assets below a few thousand dollars (limits vary by state), with certain assets excluded from counting (like a primary home up to an equity limit, one vehicle, and personal belongings). Married couples have more complex rules designed to prevent the "well spouse" from being completely impoverished when the other spouse needs nursing home care.

Because of these strict limits, many families consider transferring assets to become eligible - but this is where the look-back period becomes critical, and where planning done too late can create serious problems. If you're also working through broader estate documents, use the power of attorney builder to ensure someone can help manage the application process if needed.

What is the 5-year look-back period and why does it matter so much?

When you apply for long-term care Medicaid, the state reviews your financial transactions for the preceding 5 years (60 months) looking for transfers of assets for less than fair market value - essentially checking whether you gave away or sold assets cheaply to artificially qualify for benefits. If such transfers are found, a penalty period is calculated (based on the transferred value divided by the average cost of care in your state) during which you're ineligible for Medicaid coverage, even though you may have already spent down to qualifying asset levels.

This creates a genuinely dangerous gap: you may have too few assets to pay for care privately, but face a penalty period with no Medicaid coverage either, precisely because of a transfer made years earlier without proper planning. This is exactly why Medicaid planning should ideally begin years before care is actually needed, not in a crisis when a nursing home placement is suddenly required.

What legitimate planning strategies exist within the rules?

Certain transfers are exempt from the look-back penalty even if made shortly before applying - transfers to a spouse, transfers of a home to a caregiver child who lived with and cared for the applicant for a specified period before institutionalization, and transfers to a disabled child, among other specific exceptions. Properly structured irrevocable trusts, established well outside the look-back window, can also be a legitimate long-term planning tool for protecting assets while eventually qualifying for benefits.

"Crisis planning" (planning that begins after care is already needed) has more limited options than proactive planning, but legitimate strategies still exist even in these situations, such as spousal protections and specific permitted spend-down categories - this is exactly the kind of nuanced, state-specific analysis where an elder law attorney's guidance provides significant value. Our power of attorney builder and guardianship vs. conservatorship guide cover related elder law planning tools.

Frequently asked questions

Not immediately - a primary home is typically an excluded asset for initial eligibility purposes, up to a home equity limit that varies by state, especially if a spouse or certain other qualifying relatives continue living there. However, after the Medicaid recipient's death, most states pursue "estate recovery," seeking reimbursement from the deceased person's estate (which can include the home) for Medicaid benefits paid during their lifetime. This is why many Medicaid planning strategies specifically address protecting the home from estate recovery, not just from counting against initial eligibility limits - these are 2 separate problems requiring different planning approaches.

Federal "spousal impoverishment" protections allow the community spouse (the spouse remaining at home) to retain a portion of the couple's combined assets and income, specifically to prevent the healthy spouse from becoming impoverished when the other spouse needs institutional care. The exact protected amounts vary by state and change periodically, but this is an important protection that shouldn't be overlooked - the assumption that literally everything must be spent down before Medicaid eligibility, even for a married couple, is a common and costly misunderstanding worth clarifying with an attorney before assuming the worst.

This can be a legitimate strategy, but only if done well outside the 5-year look-back period before ever needing to apply for Medicaid, and it comes with significant tradeoffs to understand first - gifting the home outright means losing the stepped-up cost basis your heirs would otherwise receive upon your death (potentially triggering greater capital gains tax when they eventually sell), and it means genuinely giving up ownership and control, including exposure to your children's own creditors, divorces, or bankruptcies. More sophisticated approaches, like certain irrevocable trusts, can address some of these tradeoffs, but require careful drafting by an experienced elder law attorney well before care is actually needed.

This varies significantly by state - Medicaid coverage for nursing home (skilled nursing facility) care is a mandatory benefit that all states must provide to eligible individuals, but coverage for assisted living varies by state and is often provided through optional home and community-based services (HCBS) waiver programs, which frequently have limited enrollment slots and waiting lists, unlike the mandatory nursing home benefit. If assisted living rather than a nursing home is the anticipated need, confirm your specific state's waiver program availability and waiting list situation well in advance, since "Medicaid will cover it" is a less safe assumption for assisted living than for nursing home care.

Review financial records for the past 5 years for any transfers of money or property for less than full value - this includes obvious gifts, but also less obvious situations like adding a child's name to a bank account or property deed (which can be treated as a partial transfer), forgiving a loan, or selling something to a family member below market value. If you're uncertain whether a past transaction could trigger a penalty, bring your financial records to an elder law attorney for review before applying - identifying a potential issue in advance allows time to address it or plan around it, rather than being surprised by a penalty period determination after applying.