A Medi-Cal asset protection trust is an irrevocable trust that holds assets so that, if it is written so no principal can ever be paid back to the person who made it, Medi-Cal generally does not count that principal. Moving assets into it is a transfer, though, and California's 30-month look-back for nursing-home care can apply.
Most people facing this question are an adult child or a spouse watching someone they love move toward nursing-home care in California, with the monthly bills already in view. They have heard that a trust can keep the house or the savings safe, and they want to know whether that is true, what it costs the family in control, and whether the timing still works. This page walks through how Medi-Cal treats a trust, how the look-back works, what happens to the home and what the trust cannot do.
What a Medi-Cal Asset Protection Trust Is
A Medi-Cal Asset Protection Trust (MAPT) is an irrevocable trust a person creates to hold assets so those assets are not counted toward the Medi-Cal asset limit for long-term care. Medi-Cal is California's Medicaid program; it is not Medicare, and this page does not cover Medicare.
"Irrevocable" means that once the trust is signed, the person who made it, called the grantor, cannot take the assets back or change the trust's terms. That permanence is the point of the design, and also its biggest cost.
A countable asset is a resource Medi-Cal counts when deciding whether an applicant meets the asset limit. The question a MAPT tries to answer is whether assets the grantor no longer controls still count as the grantor's.
A MAPT is different from the revocable living trust many families already have. Because the grantor of a revocable trust can still reach the money, federal law treats everything in it as available to the grantor, as the next section explains. A revocable trust does not change the Medi-Cal picture.
Whether a MAPT has any effect depends on how it is written and whether it is actually funded. Federal trust rules look at the terms, not the label, and a trust that holds nothing protects nothing. What the rules allow, and what they depend on, is the subject of the rest of this page.
Do Assets in a Trust Count Toward the Medi-Cal Asset Limit?
Federal law answers this in 42 U.S.C. § 1396p(d), and the answer turns on what the trust lets the trustee do. For a revocable trust, the statute is direct: "the corpus of the trust shall be considered resources available to the individual."
For an irrevocable trust, the statute uses what is often called the "any circumstances" test: "if there are any circumstances under which payment from the trust could be made to or for the benefit of the individual, the portion of the corpus from which, or the income on the corpus from which, payment to the individual could be made shall be considered resources available to the individual."
In plain words, if there is any circumstance under which a payment could be made to or for the benefit of the grantor, the part of the corpus (or of the income on it) from which that payment could be made still counts as the grantor's resource. Subject to the trusts that paragraph (4) excludes, the statute adds that this applies "without regard to" the purposes for which a trust is established, whether the trustees have or exercise any discretion, any restrictions on when or whether distributions may be made, or any restrictions on the use of distributions.
The other side of the test is the part a MAPT relies on. A portion from which "no payment could under any circumstances be made to the individual" is not treated as an available resource. It is treated instead as a transfer of assets, as of the date the trust was set up or, if later, the date payment to the grantor was foreclosed.
Income is a separate question. Under § 1396p(d)(3), payments to or for the benefit of the grantor from a revocable trust, or from a portion of an irrevocable trust that counts as available to the grantor, are treated as the grantor's income, so how the trust handles income depends on its terms.
California applies these federal rules within its own program. The Department of Health Care Services asset limit FAQ states that on January 1, 2026, California passed a law requiring Medi-Cal to count assets for some Medi-Cal programs, so the trust question again affects eligibility, not only what happens after death.
The Look-Back Period and How It Applies to a MAPT in California
The look-back period is a window of time before a set date, during which the agency reviews asset transfers. Federally, the date is the first date on which the person both is an institutionalized individual and has applied for medical assistance (42 U.S.C. § 1396p(c)(1)(B)(ii)(I)), and the window is 60 months for transfers made on or after February 8, 2006, under § 1396p(c)(1)(B)(i). States run their own programs, and California's period is shorter.
According to the DHCS asset limit FAQ, "If you move into a nursing home, Medi-Cal will look at any assets you gave away in the 30 months before you entered the facility." The same page states that transfers made before January 1, 2026, will not be counted, and transfers made on or after January 1, 2026, may cause a penalty that delays coverage.
A penalty period is a period of ineligibility for Medi-Cal long-term-care benefits calculated from the value of assets transferred for less than fair market value. Federally, under § 1396p(c)(1)(E), the months of ineligibility equal the total uncompensated value transferred divided by the average monthly private-pay cost of nursing-facility care in the state at the time of application, and a state may not round fractions down. California's own divisor depends on its current rules.
Under 42 U.S.C. § 1396p(c)(1)(D)(ii), the penalty starts on the later of the month of the transfer and the date the person is eligible and would otherwise be receiving institutional-level care. So a gift made inside the look-back is penalized the same way however long ago, within that window, it was made.
Funding a MAPT is a transfer for less than fair market value, because the grantor receives nothing in return. A transfer into the trust is reviewed like any other gift.
Not every transfer is penalized. A transfer to the person's spouse carries no transfer penalty under 42 U.S.C. § 1396p(c)(2)(B)(i). The federal exceptions also include, among others, certain transfers of the home to listed family members, transfers to or in trust for a blind or disabled child, a satisfactory showing that the assets were transferred exclusively for a purpose other than to qualify for medical assistance, return of all the assets transferred for less than fair market value, and undue hardship. DHCS lists transfers to a spouse or someone helping the spouse, to a blind or disabled child, and sales for full value.
The Family Home and a Medi-Cal Asset Protection Trust
The home is usually the asset families care about most, and the rules here come from several directions at once. The DHCS FAQ lists the main home as not counted, and states that if a person owns the home and plans to return to it, it won't count against them, though extra homes will count.
A separate federal ceiling applies to long-term-care coverage. Under 42 U.S.C. § 1396p(f), a person whose home equity exceeds a set limit is not eligible for nursing facility or other long-term care coverage, unless a spouse, a child under 21, or a blind or disabled child is lawfully residing in the home; the statute also calls for a process to waive the limit in cases of demonstrated hardship. The 2026 CMS standards bulletin gives home-equity limits, effective January 1, 2026, of $752,000 minimum and $1,130,000 maximum; the figure California uses depends on its current rules.
A community spouse is the husband or wife of the person receiving institutional-level care, and is not in a medical institution or nursing facility themselves. The equity limit does not apply while that spouse is lawfully residing in the home.
Deeding the home into a MAPT is a transfer, so it is subject to the look-back and penalty rules described above unless an exception applies.
Estate recovery is DHCS's right to seek repayment of Medi-Cal costs from the deceased member's estate. DHCS states that for members who died on or after January 1, 2017, recovery is limited to estate assets subject to probate. Assets held in an irrevocable trust at death may not pass through probate. Whether that holds for a given home depends on the trust, its funding and California's rules at the time.
Under 42 U.S.C. § 1396p(b)(2), federal law delays recovery while a surviving spouse, a child under 21 or a blind or disabled child survives; the deferral does not cancel the claim, and under § 1396p(b)(3) the state must also have procedures to waive recovery when it would work an undue hardship.