1. Medicaid eligibility is determined solely based on Medicaid rules, not IRS gifting rules, so gifts can create periods of Medicaid ineligibility. 2. Prenuptial agreements do not impact Medicaid eligibility determination, as each spouse's assets are generally available for the other spouse's nursing home costs. 3. Long-term care insurance can benefit some by allowing them to keep more assets and still qualify for Medicaid, such as a woman who was able to protect $202,000 of her $300,000 by purchasing a $200,000 long-term care policy.

1. Medicaid/Title 19 Pointers
1. Medicaid does not care about the IRS gifting rules. A new client
came in convinced he would be eligible for Medicaid because he had
complied with the IRS annual gift exclusion rules. Unfortunately, for
Medicaid purposes, a gift is a gift and will usually create periods of
ineligibility for Medicaid. The IRS rules don’t matter.
2. I don’t have to worry about protecting my assets because I have a
prenuptial agreement. Unfortunately, prenuptial agreements have no
significance in the Medicaid process. Each spouse’s assets, with
some exceptions, are available for nursing home costs.
3. Long-term care insurance won’t benefit me. This is often incorrect.
This case involved a single person who wanted very much to pass on
her estate to her nephews. She had $300,000. She had reason to
believe she could spend time in a nursing home based on family
history. Under the Medicaid guidelines, she could keep only $2,000 to
qualify and the rest would be spent on her care. By purchasing a
qualified long-term care policy with a $200,000 benefit, she now would
be able to keep $202,000 of her assets and still qualify for Medicaid.
4. My husband entered a nursing home last week so I have no
planning options. This is false. Although the look-back is confusing,
there are almost always options even at the midnight hour. Often,
these options hinge on the thoroughness of the general durable power
of attorney.