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Medicaid and Long-Term Care Planning

Nursing home care can consume an estate in under two years. Planning ahead for Medicaid eligibility, and what can still be done once a family is already in crisis.

Most families come to this subject in a hospital corridor, after a fall or a stroke, when a discharge planner has started using the phrase “private pay.”

It is worth understanding earlier, because nearly everything useful becomes harder once the clock has started.

What we help with

Planning ahead, where the five year lookback is clear and the range of options is widest. How the home is titled, which assets are countable and which are excluded, and whether long-term care insurance makes sense while someone is still insurable.

Crisis planning, where someone is already in a facility or about to be. The lookback cannot be undone, but families are frequently told nothing can be done at all, and that is not true. Spousal protections, permitted spend-down, and corrections to how assets are titled can all still matter.

Protecting the spouse who stays home. For a married couple this is usually the heart of it. Federal spousal impoverishment rules let the healthy spouse keep a share of the couple’s assets and, in some circumstances, part of the applicant’s income.

The mistake that causes the most damage

Giving assets away shortly before applying.

Michigan reviews transfers going back five years. Assets given away or sold for less than value in that window trigger a divestment penalty, and the penalty does not begin when the gift was made. It begins when the person would otherwise have qualified.

So a parent who deeds the house to a child to protect it can create a period of ineligibility at exactly the moment care is needed, with the asset already gone and no way to pay privately through the wait.

Where this meets your estate plan

Michigan operates a Medicaid estate recovery program. After a recipient dies, the state may seek reimbursement for benefits paid, and it pursues that claim against the probate estate.

That is one more reason how your home is titled, and whether a trust was ever actually funded, matters long before anyone is thinking about a nursing facility.

An honest word

This is technical work, the figures move every year, and the stakes are somebody’s home. It is also a field with a lot of bad advice circulating, most of it a version of “just give it to the kids,” which is the specific move most likely to cause a penalty.

We do not handle veterans benefits claims.

Related reading

Is care on the horizon, or already here?

Either way the first step is a conversation about what is actually owned and how it is titled. That call is free.

Schedule a Free Call