Irrevocable income-only trust funded 5+ years before Medicaid application shelters home and assets from spend-down.
Medicaid long-term care ($8K–$15K/mo nursing home) requires spend-down to ~$2K in most states. A MAPT (irrevocable, income-only, grantor trust) removes assets from Medicaid's countable pool AFTER the 5-year lookback expires. Grantor retains income + right to live in transferred home + §121 exclusion + basis step-up at death. Assets pass outside probate to beneficiaries. Plan by age 70 to survive the lookback.
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.
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.
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.