← 24Help.org
🔍
Medicaid Under Attack? CDR Help
24help.org

Long-Term Care Planning

Navigate Medicaid spend-down, asset protection, and care options — step by step, at no cost.

Built by a former SSA District Manager
🏠

Where are you in this process?

Pick the option that best describes your situation.

We'll guide you step-by-step based on your choice.

🚨

Urgent Action Needed

You need care now — don't panic!

⚠️ Don't transfer assets hastily: This can cause a Medicaid penalty. Follow these critical steps first.
1
Assess immediate care needs. Evaluate the level of care required by your loved one.
2
Contact your local Area Agency on Aging at eldercare.acl.gov or by calling 1-800-677-1116.
3
Apply for Medicaid immediately to qualify for "Medicaid pending" status. Begin the application process now.
4
Consider hospital discharge planning if your loved one is currently hospitalized. Engage with the hospital's social worker.
Insider Tip from Dr. Ed
Many nursing homes accept residents with Medicaid pending status — there's no need to wait for full approval to get care.
📋

Long-term planning

Steps to take when planning ahead

  • 1

    5+ years out

    Consider long-term care insurance, begin a gifting strategy within annual limits, and consult an elder law attorney.

  • 2

    3-5 years out

    Review all assets, consider an irrevocable trust, and maximize the Community Spouse Resource Allowance (CSRA).

  • 3

    1-2 years out

    Implement Medicaid planning strategies and choose preferred facilities for care.

  • 4

    6 months out

    Gather financial documents and apply for Medicaid. Ensure all documents are in order for a smoother transition.

Insider Tip from Dr. Ed
The look-back clock starts from each individual transfer date, not from when you start planning, so begin early.
🏥

Medicaid explained

Understanding Medicaid eligibility

Income limits: Approximately $2,982/month for nursing home care. Asset limit: $2,000 for singles (varies by state).
✓
Exempt assets: primary home (equity limit $752,000-$1,130,000), one vehicle, personal belongings, prepaid irrevocable funeral plan, term life insurance, household goods.
Insider Tip from Dr. Ed
Your home is usually exempt while you or your spouse lives there, but Medicaid can place a lien and recover costs through estate recovery after death.
🏠

Care options

Comparing care types

Cost: ~$9,000-$12,000/month. Provides 24/7 skilled nursing. Medicaid typically covers this cost.
Cost: ~$4,500-$7,000/month. Assistance with daily activities. Coverage varies — some states offer waivers.
Cost: ~$5,000-$8,000/month. Care provided at home. Home and Community-Based Services (HCBS) waivers may cover costs.
Insider Tip from Dr. Ed
HCBS waivers often have waiting lists in many states — apply early even if you don't need care right now.
⏳

Understand the Look-Back Period

The 5-Year Look-Back Period

1
Transfers of assets for less than fair market value in the 60 months before Medicaid application trigger a penalty period.
2
Penalty period: value transferred ÷ average monthly nursing home cost in your state. Starts upon Medicaid application.
Exceptions: Transfers to spouse, disabled child, trust for blind/disabled child, home to caregiver child (2+ years), home to sibling with equity interest.
Insider Tip from Dr. Ed
The penalty period starts at the application date, not the transfer date — this surprises many and can leave gaps in coverage.
🔑

Protect Your Assets

Asset protection strategies

  • 1

    Community Spouse Resource Allowance (CSRA)

    $32,532-$162,660 (2026). Protect assets for the community spouse.

  • 2

    Miller Trust/Qualified Income Trust

    Used in income-cap states to qualify income for Medicaid.

  • 3

    Medicaid-compliant annuities

    Convert countable assets to an income stream.

  • 4

    Irrevocable trusts

    Must be established 5+ years before application.

  • 5

    Caregiver agreements

    Pay family members for providing care at fair market rate.

Insider Tip from Dr. Ed
The community spouse can request a fair hearing to retain more than the standard CSRA, in some cases up to all the couple's assets.
👫

Spousal protection

Understanding spousal protection rules

1
Community spouse retains: home, one car, CSRA ($32,532-$162,660).
2
Monthly Maintenance Needs Allowance (MMNA) is $2,643.75-$4,066.50/mo (2026).
3
If the community spouse's income is below the MMNA, they can use the institutionalized spouse's income.
4
Right to a fair hearing to increase the CSRA amount.
Insider Tip from Dr. Ed
Consult an elder law attorney — spousal protection strategies can save thousands. The fair hearing right is particularly powerful.
📧

Stay Informed

Get a printable guide sent to your inbox

Receive a comprehensive version of this guide, plus updates when the rules change.

❓

FAQs

Frequently Asked Questions

Medicare is a federal health insurance program, while Medicaid is a state and federal assistance program for low-income individuals. Medicare typically doesn’t cover long-term care, while Medicaid does for those who qualify.
Typically, your home is exempt while you or your spouse lives there, but post-death, Medicaid can pursue estate recovery unless specific exemptions apply.
A Miller Trust (or Qualified Income Trust) is used to help those in income-cap states qualify for Medicaid by redirecting excess income.
Typically, the application can take from 45 to 90 days, but this varies by state and complexity of case.
You have the right to appeal a Medicaid denial. Provide additional documentation and request a fair hearing.
Medicaid beneficiaries can choose from any facilities that accept Medicaid and have available beds.
Medicaid coverage for assisted living and home care varies by state; some offer HCBS waivers or other options.

Need to start over?

Go back to the beginning and choose a different path.

Long-Term Care Planning Navigator — a free tool from 24help.org
Built by Dr. Ed Weir, former SSA District Manager
Educational resource only. Not legal advice. Always verify with local authorities.