08/04/2026
💰 Medicaid will pay for nursing home care — but in most states, you must spend down nearly all of your assets before you qualify.
That's the choice most families face: a nursing home private room now runs $127,750 a year, and very few people can pay that out of pocket for long.
So here's how Medicaid spend-down actually works, step by step:
1. **Asset limit**: In most states, a single person can keep only about $2,000 in countable assets. Your home, one car, personal belongings, and a prepaid burial plan are typically exempt — everything else counts.
2. **Income rules**: Your monthly income goes toward the cost of care first. Medicaid covers what you can't pay. If you're married, your spouse at home can keep a protected amount of income and assets.
3. **Lookback period**: Medicaid reviews 60 months of financial records. Any gifts or transfers for less than fair value during that window can trigger a penalty period where you're ineligible for coverage.
4. **What to do NOW**: If long-term care is a possibility — even years away — talk to an elder law attorney before you make any large gifts, transfers, or financial moves. The lookback clock starts the day you apply, and mistakes made years earlier can cost you months of coverage.
Medicaid planning is legal. Ignoring it until you need care is expensive.
Have you had this conversation with your family yet? What's holding you back?
