Medicaid Long-Term Care Basics: Look-Back, Estate Recovery and Spousal Protections

When you apply for Medicaid nursing-home or home-care coverage, federal law has the state review gifts and transfers of assets for less than fair value made in the 60 months (5 years) before you applied. A transfer inside that window can create a penalty period during which Medicaid does not pay for that care. Florida, for example, describes it as assets transferred within the last 60 months.

States must seek repayment from the estate of a person who was 55 or older when they received nursing-facility services, home- and community-based services and related hospital and prescription drug services. States may extend recovery to other services.

Federal law also sets limits. Recovery waits until after a surviving spouse has died, and it cannot happen while a child under 21, or a blind or disabled child, survives. States must have hardship waivers. Help with Medicare costs through a Medicare Savings Program is excluded from recovery.

When one spouse needs nursing-home or waiver care and the other stays at home, spousal impoverishment rules let the spouse at home keep a share of the couple's resources and some income, so they are not left without means. States set their own figures within federal ranges, which CMS publishes each year.

Social Security has announced the 2027 SSI federal payment: $1,029 for an individual and $1,544 for a couple, starting January 2027. Other 2027 long-term care figures had not been published when we wrote this.

In some states, people whose income is above the special income level use a qualified income trust (sometimes called a “Miller trust”) to qualify for nursing-home Medicaid. Texas, Arizona, Florida and Indiana describe this option in their state materials.

The most integrated Medicare plans for people with Medicaid, called FIDE SNPs, cover long-term services and supports along with Medicare benefits through one organization. Whether that is available depends on your state. Our guide to integrated D-SNPs explains the levels, and the state guides name each state's long-term care program.