Eldercare Planning
Medicaid planning for long-term care, minus the internet myths
Medicaid is the largest payer of long-term care in America, and the most misunderstood. Half the internet says give everything away; the other half says you have to die broke. Both halves are wrong.
What is Medicaid planning?
Medicaid planning arranges a family's finances so a parent can qualify for Medicaid's long-term care coverage while keeping what the rules legitimately protect: a healthy spouse's income and assets, an exempt home in many situations, and transfers timed outside the 60-month look-back period.
How the program actually works
Medicaid pays for nursing home care (and, through waiver programs, some home and community care) once a person's countable assets fall below strict limits. It's state-administered, so Maryland's numbers and procedures govern here. The rules are strict but not cruel: they include real protections, especially for a spouse still living at home, that most families never claim because nobody told them.
The look-back, told straight
When your parent applies, Maryland reviews 60 months of financial history. Gifts and below-market transfers inside that window create a penalty period during which Medicaid won't pay, calculated by dividing what was given away by the state's average monthly care cost. That's why the classic panic move, handing the kids money on the way to the nursing home, backfires. And it's why families who plan at 75 have options that families who plan at discharge don't.
Myth vs. reality
| The myth | The reality |
|---|---|
| "Give everything to the kids now." | Transfers inside 60 months trigger penalties, and transfers outside it have their own tax and control problems. Sometimes right, never casual. |
| "Medicaid takes the house." | A primary residence is often exempt while a spouse or certain relatives live in it. Estate recovery afterward has limits. Specifics decide. |
| "The healthy spouse is left with nothing." | Spousal impoverishment rules protect a share of assets and income for the spouse at home. Claiming them fully is planning, not luck. |
| "It's too late once care starts." | Legitimate strategies exist even mid-crisis. Fewer than at 75, more than zero. Worth one conversation to find out which. |
How we work it
Medicaid planning is a two-seat exercise. An elder law attorney handles the legal structures and the application strategy; we handle the financial machinery: projecting the care-cost runway, positioning income and assets, keeping the healthy spouse's retirement intact, and making sure every move fits the family's larger plan. We'll refer you to attorneys we trust and stay at the table throughout.
Written by Colin Meeks, CFP® · Maryland Financial Advocates · Last updated August 6, 2026
Questions people actually ask
The state adds up gifts and below-market transfers made in the 60 months before applying, then divides by Maryland's average monthly nursing home cost figure. The result is the number of months Medicaid won't pay. A $60,000 gift works out to several months of self-pay, starting when your parent is otherwise eligible, which is the worst possible timing.
Start with a 15-minute call. It's complimentary.
Tell us what's on your plate. We'll tell you honestly whether we can help, and you'll know exactly what working together costs before you commit to anything.
Prefer the phone? Call 410-663-0700 and ask for Colin.