Medicaid Asset Protection Trust (MAPT): What It Is and How It Works

A Medicaid asset protection trust is an irrevocable trust a person funds while living, giving up any right to take the principal back. Funding it counts as a transfer, so it falls under the look-back period. Once that period has run, the funding transfer falls outside the look-back, and under 42 U.S.C. § 1396p(d)(3)(B) a portion of the trust from which no payment could be made to the person is treated as assets disposed of by the person for purposes of the transfer rules.

This page is written for an adult child or a spouse whose family member needs, or will soon need, long-term care. The word "trust" covers many kinds of arrangement, and only some of them matter to Medicaid. This page explains how a MAPT works under federal law, what it depends on, and where each state's own Medicaid program changes the picture.

What a Medicaid Asset Protection Trust Is

A Medicaid asset protection trust (MAPT) is an irrevocable trust that a person creates and funds during life. The aim is that, once the look-back period has passed, the assets inside it are not counted as that person's countable assets when Medicaid decides eligibility for long-term care. A countable asset is an asset Medicaid counts when it decides whether a person meets the asset limit. Families also hear the terms irrevocable Medicaid trust and irrevocable income-only trust. An irrevocable Medicaid trust is one the grantor cannot cancel or change to get the property back. An income-only trust is one that may pay the grantor the income the assets earn but never the principal.

The reason irrevocability matters is in the federal statute. Under 42 U.S.C. § 1396p(d)(3)(A), "in the case of a revocable trust— (i) the corpus of the trust shall be considered resources available to the individual." Corpus means the trust's principal. An ordinary revocable living trust therefore protects nothing for Medicaid, because the person can take the assets back at any time.

An irrevocable trust is treated differently. Under 42 U.S.C. § 1396p(d)(3)(B), any portion of the trust from which "no payment could under any circumstances be made to the individual" is treated as assets disposed of by the person for purposes of the transfer rules in § 1396p(c), as of the date the trust was established or, if later, the date payment to the person was foreclosed. A person is considered to have established a trust when the person's assets formed all or part of its corpus and the person, the person's spouse, someone with legal authority to act for either, or someone acting at the direction or request of either established it other than by will (§ 1396p(d)(2)(A)). These rules do not apply to the trusts described in § 1396p(d)(4), which include certain trusts for a disabled person under 65 and certain pooled trusts for disabled persons managed by a non-profit association.

Federal law in 42 U.S.C. § 1396p sets these trust and transfer rules. Each state runs its own Medicaid program, with its own rules, inside that framework.

The Look-Back Period and Why Timing Matters

Federal law sets the look-back at 60 months for any transfer made on or after February 8, 2006, under 42 U.S.C. § 1396p(c)(1)(B)(i). The look-back period is the window before a Medicaid application during which the agency reviews gifts and other transfers. For a person in a nursing home, the window is measured back from the first date the person is both institutionalized and has applied. The federal rule is 60 months, but states run their own programs, so the look-back that applies to a particular person depends on that state's current rules.

A penalty period is a stretch of time during which a person cannot receive Medicaid long-term-care benefits because assets were transferred for less than fair market value. For a person in a nursing home, the number of months equals the total, cumulative uncompensated value of all assets transferred by the person or the person's spouse on or after the look-back date, divided by the average monthly cost to a private patient of nursing facility services in the state (or, at the state's option, in the community where the person is institutionalized) at the time of application, under § 1396p(c)(1)(E)(i). A state may not round down or otherwise disregard a fractional period (§ 1396p(c)(1)(E)(iv)).

Under 42 U.S.C. § 1396p(c)(1)(D)(ii), the penalty begins on the later of two dates. One is the month of the transfer. The other is the date the person is eligible for Medicaid and would otherwise be receiving institutional-level care based on an approved application, but for the penalty. The start cannot fall during another period of ineligibility. So a gift made four years before applying and a gift made last month, if both fall inside the look-back and both were made before the person became otherwise eligible, start their penalty on the same date.

Some transfers carry no penalty. A transfer to the person's spouse carries none under § 1396p(c)(2)(B)(i). The other exceptions in § 1396p(c)(2) include:

• a home transferred to a child under 21, to a blind or disabled child, to a sibling with an equity interest who lived there at least a year immediately before the person became institutionalized, or to a son or daughter who lived there at least two years immediately before and, as the state determines, gave care that kept the parent at home;
• assets transferred to a blind or disabled child, or to a trust established solely for that child's benefit, or to a trust established solely for the benefit of a disabled person under 65 (including a trust described in § 1396p(d)(4));
• cases where the person makes a satisfactory showing to the state that the assets were transferred exclusively for a purpose other than to qualify for medical assistance, that the person intended to dispose of them at fair market value or for other valuable consideration, or that all assets transferred for less than fair market value have been returned;
• cases where the state determines that denying eligibility would work an undue hardship.

Funding a MAPT is a transfer for less than fair market value. Under § 1396p(d)(3)(B) it is treated as made on the date of funding (or, if later, the date payment to the person was foreclosed), so a penalty period can follow if that date falls inside the look-back period. For care that is needed now, see Medicaid crisis planning.

What Assets Can and Cannot Go Into a MAPT

Assets families discuss for a MAPT include the family home, bank accounts, and brokerage and investment accounts. Which assets belong in any given trust is a planning decision. Placing an asset in a trust does not by itself mean the asset will be protected.

The home has its own federal rule. Under 42 U.S.C. § 1396p(f), a person whose equity interest in the home is above a set limit is not eligible for nursing-facility or other long-term-care Medicaid coverage, unless a spouse, a child under 21, or a blind or disabled child is lawfully residing in the home; the statute also provides for a hardship waiver. Under the CMS 2026 standards chart, effective January 1, 2026, the federal home-equity limits range from a minimum of $752,000 to a maximum of $1,130,000. Each state sets its own figure within that range, and the figures are adjusted every year.

Retirement accounts such as IRAs and 401(k)s raise income-tax questions that depend on the person's situation, and this site does not give tax advice. How a state treats a retirement account for Medicaid is a separate question that depends on that state's rules.

Whether a particular asset ends up protected depends on three things: the terms of the trust, the state's Medicaid rules, and whether the look-back period has run since the asset was transferred. For families comparing a trust with spending assets down, the Medicaid spend-down process works on a different set of rules. Readers in California can see how Medi-Cal asset limits apply there.

How a MAPT Is Structured: Trustee, Beneficiaries, and the Income-Only Feature

The grantor is the person who creates and funds the trust. The grantor cannot keep the right to take back principal. A power to revoke makes the trust revocable under 42 U.S.C. § 1396p(d)(3)(A). Any circumstance under which principal could be paid to or for the grantor makes that principal available under § 1396p(d)(3)(B).

A MAPT may be drafted as an income-only trust. The grantor may receive the income the trust assets produce, such as interest, dividends or rent, but never the principal. Section 1396p(d)(3)(B) supports this split. It counts as available only the portion of corpus, or the income on corpus, from which payment to the grantor could be made, and it treats payments from that portion to the grantor as the grantor's income.

That income still counts. In this setting, income means the money the trust pays to the grantor, and Medicaid counts it when it applies its income rules.

The trustee manages and invests the assets under the trust's terms. Who may serve as trustee, and what powers the trustee holds, bear on whether payment to the grantor could be made, so they depend on the trust's terms and the state's rules.

The remainder beneficiaries, often the grantor's children, receive what is left after the grantor's death, subject to the estate recovery rules discussed in the next section.

What counts as a valid MAPT depends on the state's current Medicaid rules.

Estate Recovery and What Happens After Death

Estate recovery is the process by which a state seeks repayment from a Medicaid recipient's estate for long-term-care benefits it paid. According to Medicaid.gov's eligibility policy page, state programs must recover from an enrollee's estate the cost of certain benefits. These include nursing facility services, home and community-based services, and related hospital and prescription drug services. States may also recover for other benefits, except Medicare cost-sharing paid for Medicare Savings Program beneficiaries. Under 42 U.S.C. § 1396p(b)(1), that mandatory recovery applies to individuals who were 55 or older when they received the benefits and, whatever their age, to certain institutionalized individuals described in § 1396p(a)(1)(B).

Under 42 U.S.C. § 1396p(b)(2), recovery may be made only after the death of the individual's surviving spouse, if any, and only at a time when there is no surviving child under 21 or blind or disabled child. States must also have procedures to waive recovery where it would work an undue hardship (§ 1396p(b)(3)). For a family worried about a parent's house, a surviving spouse or a qualifying child therefore postpones recovery, and what can be recovered later depends on the state's rules.

Whether MAPT assets can be reached depends on state law. Some states define the "estate" as probate assets only. Others reach further, to non-probate property such as some trust assets. Trust assets that pass to remainder beneficiaries outside probate may, in some states, fall outside estate recovery. That result depends entirely on the state's definition of "estate" and on how the trust is built, and no one can promise it. The scope of recovery for any particular person depends on that state's current rules.

A MAPT Compared to a Revocable Living Trust and a Standard Irrevocable Trust

The three kinds of trust work very differently for Medicaid.

Revocable living trust. The grantor keeps control and can amend or revoke the trust. Under 42 U.S.C. § 1396p(d)(3)(A), its corpus is treated as available to the grantor, so it does not protect assets from Medicaid. In the Medicaid setting, that is its main downside. Whatever other purposes it serves, it offers no Medicaid asset protection.

Standard irrevocable trust. Being irrevocable is not enough on its own. Under § 1396p(d)(3)(B), only the portion of principal from which no payment could be made to or for the grantor is outside available resources. An irrevocable trust that lets a trustee pay principal to the grantor, even rarely or only in the trustee's discretion, may still count as an available resource. Section 1396p(d)(2)(C) applies these rules regardless of trustee discretion or limits on distributions.

MAPT. A MAPT is drafted to meet the § 1396p(d)(3)(B) standard. It is irrevocable, it allows no payment of principal to or for the benefit of the grantor, and the look-back period must run from the date it is funded.

Does a "family trust" protect assets from Medicaid? The answer depends on whether it is revocable or irrevocable and on its exact terms. A revocable family trust does not. An irrevocable one may, depending on its terms and the state's rules.

The main trade-off of a MAPT is the loss of direct control over principal. The grantor cannot take the assets back. Each structure does something different, and which fits a family depends on facts and state rules this page cannot weigh.

What a MAPT Does Not Cover and When It May Not Apply

If a person needs Medicaid before the look-back period has run from the date of funding, the funding is a transfer inside the look-back, and a penalty period can apply unless an exception in § 1396p(c)(2) fits.

A MAPT also does not remove income from the picture. Medicaid has income rules as well as asset rules, and payments the trust makes to the grantor count as the grantor's income. Married couples face separate spousal rules. According to CMS's spousal impoverishment page, these rules protect a share of the couple's resources and income for the community spouse, meaning the spouse who remains at home. The 2026 federal resource figures, effective January 1, 2026, are a minimum of $32,532 and a maximum of $162,660. Each state applies its own figure from the date its rules state. Florida's figures are covered under Florida Medicaid planning.

State rules vary in ways that change the analysis, including:

• what counts as a valid MAPT;
• which assets are exempt;
• the length of the look-back period;
• how estate recovery is applied.

All of these depend on the state where the person applies.

This site covers Medicaid for long-term care. It does not cover Medicare, private long-term-care insurance or veterans' benefits. It also gives no tax advice: funding a MAPT may carry tax consequences that depend on the person's situation. This page explains the federal framework and the general structure of a MAPT. It does not cover every state's rules, and the rules that apply to a particular person depend on that state's current Medicaid program.

If You'd Like to Talk Through Your Situation

Whether a MAPT fits a family turns on details that general rules cannot settle: when each asset would move, how much time may remain before care is needed, whether a spouse is at home, and which state's program applies.

You can send a consultation request about your family's Medicaid and long-term-care options through Medicaid Asset Protection Group; requests may be passed to attorneys who decide for themselves whether to respond.