A Medicaid planning attorney helps a family arrange its assets, income and paperwork so that a person who needs nursing-home or other long-term care can apply for Medicaid under the rules of their state. The work covers which assets count, gifts made in the past five years, what a spouse at home may keep, the application and appeals, and what the state may claim after death.

Most people facing this question are a husband, a wife or an adult child who has just heard a nursing home quote a monthly price. They may be holding a parent's bank statements, an IRA statement and a deed to the family house, and wondering what Medicaid will count, whether an old gift to a grandchild will cause trouble, and what the spouse at home will have left. This page explains the federal rules that frame those questions, and where each state's own program takes over.

What a Medicaid Planning Attorney Does

Medicaid is a joint federal and state program, as the CMS eligibility policy page describes it. Federal law sets the framework every state follows, and each state runs its own long-term-care program with its own limits, forms and procedures. That split is why a rule that holds in one state may not hold in the next.

A Medicaid planning attorney works inside that framework on four connected questions. The first is countable assets. A countable asset is one the state counts when it decides whether an applicant meets the asset limit. The second is the look-back period, covered below. The third is spousal impoverishment protection, which shields part of a married couple's resources and income for the community spouse: the husband or wife who stays at home while the other receives institutional-level care. The fourth is the application itself, along with any denial or appeal.

How the Look-Back Period Works

Federal law sets a 60-month look-back for any transfer of assets made on or after February 8, 2006 (42 U.S.C. § 1396p(c)(1)(B)(i)). The look-back period is the window of time before a Medicaid application during which the state reviews transfers. For a person in a nursing home, it is measured back from the first date the person is both institutionalized and has applied. How a particular state applies it depends on that state's current rules, so it is not safe to assume every state handles it the same way.

A transfer for less than fair market value inside the look-back can lead to a penalty period. A penalty period is a stretch of ineligibility for institutional-level care. Its length is the total uncompensated value transferred divided by the average monthly private-pay cost of nursing-home care in the state.

The penalty starts on the later of two dates. One is the first day of the month of the transfer. The other is the date the person is otherwise eligible and would be receiving institutional-level care based on an approved application (42 U.S.C. § 1396p(c)(1)(D)(ii)). Because of that start date, a gift made four years ago inside the look-back is penalized the same way as a gift made last month.

Countable and Exempt Assets Under Federal Medicaid Rules

For a married couple, the Community Spouse Resource Allowance (CSRA) is the share of the couple's countable assets the community spouse may keep. The minimum monthly maintenance needs allowance (MMMNA) is the minimum monthly income the community spouse is entitled to keep, partly from the other spouse's income if needed. Under the CMS 2026 standards bulletin, the federal resource allowances and the maximum income allowance change each January, while the MMMNA changes each July 1. A state's own figures apply from the date that state sets.

Spend-down is the process of reducing countable assets to the limit through allowable spending.

Planning Tools Medicaid Attorneys Work With

None of the tools below fits every family, and each depends on dates, values and the state's rules. The point of understanding them is to know what questions a family's own documents raise.

Irrevocable trusts. CMS explains that when a person, a spouse or someone acting for them sets up a trust with at least some of the person's funds, that trust can be treated as available to the person (CMS eligibility policy). Payments from a trust that are treated as transfers fall under the 60-month look-back. Whether a given trust is counted turns on its terms and timing, so no trust protects assets in every case.

Spend-down. Spending countable assets on allowable items reduces the countable total. What counts as allowable depends on the state.

Estate Recovery: What Happens After a Medicaid Recipient Dies

Estate recovery is the process by which a state seeks repayment from a deceased Medicaid recipient's estate for long-term-care benefits it paid. Under 42 U.S.C. § 1396p(b)(1), a state must seek recovery for a person who was 55 or older when the care was received, covering nursing facility services, home and community-based services, and related hospital and prescription drug services; a state may also recover for other services, with exceptions. Recovery is also required from the estate of a permanently institutionalized person whose property carried a Medicaid lien.

Recovery is deferred while a surviving spouse, a child under 21, or a blind or disabled child of any age survives (42 U.S.C. § 1396p(b)(2)). The deferral postpones the claim; it does not cancel it. States must also have procedures to waive recovery when it would cause undue hardship (42 U.S.C. § 1396p(b)(3)), as the CMS estate recovery page also states.

For a family that has kept the house through years of care, this is often the question that matters most. Whether the home is reached after death depends on how that state defines the estate, and nothing in the federal framework makes the home safe from recovery whatever its value.

When to Involve a Medicaid Planning Attorney

Timing shapes the options. Because the look-back is measured back from the application date, transfers and arrangements made well before a nursing-home admission are reviewed under different facts than those made in the weeks before an application. The planning before a nursing home page covers that earlier stage, and the Medicaid crisis planning checklist covers care that is needed now.

Certain situations tend to bring families to an attorney:

Each state has its own agency, required documents and appeal rights. An attorney familiar with that state's program works with those specifics. Involving one does not by itself make anyone eligible, protect a given asset or avoid a penalty.