Moving into a nursing home can be expensive, costing you $5,000 to $10,000 a month or more. More in Massachusetts, with the average monthly cost of skilled care being $15,000. This expense can quickly wipe out your life savings. Medicaid will pick up the bill for you, if your income and assets are low enough to qualify for Medicaid benefits. The problem is you typically have to be nearly destitute before you can qualify for Medicaid.
If you put your assets into a Medicaid Asset Protection Trust, however, you might be able to qualify for Medicaid, even if your assets exceed the limit. Here is what you need to know about a Medicaid Asset Protection Trust (MAPT).
Medicaid Income and Asset Limits
Eligibility for Medicaid varies by state. In general, you must have little or no income and few countable assets. Each state also has non-economic requirements, such as age, disability and household size, depending on your circumstances.
Medicaid does not count all of your assets toward the asset limit. For example, if you or your spouse live in your primary house, Medicaid considers the home an exempt asset. The value of that property does not count toward your state’s asset limit. There are limits on the amount of equity that does not count. The limits vary from state to state.
Additional examples of assets that can be exempt, include one car, term life insurance, household furnishings, clothing, wedding and engagement rings and other personal items. Medicaid does not count prepaid funeral and burial plans or life insurance policies with little cash value toward the limit.
Medicaid does count these things toward the asset limit:
- Bank accounts
- Vacation homes
- Retirement accounts not yet in payout status (only in some states). In Massachusetts, all retirement account whether in payout status or not are countable.
These are the general guidelines. Your state’s treatment of assets might differ.
How a MAPT Works
When you put your assets into a Medicaid Asset Protection Trust (MAPT), Medicaid does not count those things toward the asset limit after a certain period of time. You do not own those items – the trust does. Medicaid does not count an asset that does not belong to you. The trust can protect the assets for distribution one day to your beneficiaries.
Please note that a “Medicaid Asset Protection Trust” can also go by the name of “Medicaid Planning Trust,” “Home Protection Trust,” or “Medicaid Trust.” Make sure that the trust you select is Medicaid-compliant. Most revocable living trusts, family trusts, irrevocable funeral trusts, and qualifying income trusts (QITs, also called Miller trusts) are not Medicaid-compliant. They will not protect your assets, if you want to be eligible for Medicaid to pay for a nursing home.
Essential Aspects of MAPTs
MAPTs are sophisticated estate planning documents. Here are a few of the highlights of these documents:
- You cannot create a MAPT and immediately apply for Medicaid. You will have to wait at least five years before you apply for Medicaid, after setting up a MAPT. If you apply for Medicaid before the “look back” period expires, you could face harsh financial penalties.
- You are the grantor of your trust. You state might use a different term, like the trust-maker or settlor. It is preferable that your adult child/children or some other individual be the trustee of your MAPT.
- The trust must be irrevocable. Once signed, you can never change the trust. You can, however, change the beneficiaries of your trust by exercising a testamentary limited power of appointment and executing a new will. Your beneficiaries can therefore change. And, you appoint a Trust Protector who can make limited changes to your trust to modify the trust to comply with any changes in the Medicaid regulations during the look back period or the period of time prior to your need for skilled care and application for benefits. If you create a revocable trust, Medicaid will count all the assets in the trust toward the asset limit because you still have control over the assets. Creating an irrevocable trust is the only type of trust that will achieve the objective of qualifying for Medicaid.
- The trustee must follow the instructions of the trust. No funds of the trust can be used for your benefit.
- A MAPT protects your assets from Medicaid estate recovery. Without a MAPT, after you die, the state could seek reimbursement from your estate for all the money they paid for your long-term care.
- The rules for MAPTs vary from one state to the next.
The regulations are different in every state. You should talk to an elder law attorney in your area to see how your state varies from the general law of this article.
American Council on Aging. “How Medicaid Planning Trusts Protect Assets and Homes from Estate Recovery.” (accessed December 19, 2019) https://www.medicaidplanningassistance.org/asset-protection-trusts/
American Council on Aging. “How to Spend Down Income and/or Assets to Become Medicaid Eligible.” (accessed December 19, 2019) https://www.medicaidplanningassistance.org/medicaid-spend-down/