Ladybird deed transfers home at death with §1014 step-up, avoids probate, and doesn't trigger Medicaid transfer.
An Enhanced Life Estate Deed (Lady Bird Deed, valid in FL, TX, MI, VT, WV) transfers remainder interest to beneficiaries while grantor retains full control — including the right to sell/mortgage/revoke. Because grantor retains the power to defeat the transfer, it's not a completed gift for Medicaid purposes (no transfer penalty) but at death passes outside probate with full basis step-up. Costs $100–$500 vs $5K+ for a trust.
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Irrevocable income-only trust funded 5+ years before Medicaid application shelters home and assets from spend-down.
Transfer the primary residence to an adult child who lived there caregiving for 2+ years — no Medicaid transfer penalty.
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.
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.