Transfer the primary residence to an adult child who lived there caregiving for 2+ years — no Medicaid transfer penalty.
42 U.S.C. §1396p(c)(2)(A)(iv) exempts the transfer of a Medicaid applicant's home to an adult child who (1) lived in the home for at least 2 years immediately before institutionalization, and (2) provided care that delayed institutional placement. Requires a physician letter documenting the delayed-placement care. Bypasses the 5-year lookback entirely — home transfers even ON Medicaid application day.
Click Generate advisory deep dive for mechanics, IRC citations, a step-by-step execution plan, a worked numeric example on your profile, costs, risks, and this-week actions.
Irrevocable income-only trust funded 5+ years before Medicaid application shelters home and assets from spend-down.
In select states, the well spouse refuses to contribute — Medicaid must cover institutionalized spouse, may sue later.
Wartime-era veterans (or surviving spouses) needing help with ADLs get up to $2,795/mo tax-free — stacks with Medicaid.
Written contract paying an adult child market rate for caregiving spends down assets without Medicaid transfer penalty.
Immediate irrevocable annuity converts spend-down assets into an income stream for the community spouse.
Ladybird deed transfers home at death with §1014 step-up, avoids probate, and doesn't trigger Medicaid transfer.
Post-65, HSA funds pay Medicare Part B/D/Advantage premiums + LTC insurance premiums tax-free.
Combo policies give LTC benefits if needed, death benefit if not — no 'use it or lose it' like standalone LTC.