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Elder care in California

Do I (or a relative) qualify for Medicaid? Quick check

Answer each question yes or no for a rough first answer. The figures are California's.

Each question says what a yes and a no mean.

  1. Is the person 65 or older, or blind or disabled?

    If yes: This group can get nursing-home Medicaid.

    If no: Nursing-home Medicaid for older adults covers people 65 or older, blind or disabled. Other Medicaid groups may still fit; ask the agency.

  2. Do they live in California (or plan to stay there)?

    If yes: Apply in California.

    If no: Apply in the state where they live and mean to stay; each state has its own figures.

  3. Are they a U.S. citizen or a qualified immigrant?

    If yes: Meets this requirement.

    If no: Without citizenship or qualified-immigrant status, Medicaid generally covers only emergencies.

  4. Do they need nursing-home-level care (help with daily activities like bathing, dressing, eating, or constant supervision)?

    California decides this with an assessment.

    If yes: Expect an assessment before approval.

    If no: Nursing-home Medicaid requires this level of care. Other programs may help instead (see the result).

  5. Is their monthly income (before deductions) less than the monthly cost of their nursing-home care?

    California has no fixed dollar income limit for nursing-home Medicaid: income goes toward the cost of care.

    If yes: Income passes. Once approved, most of it still goes toward the nursing home each month.

    If no: In California, income goes toward the cost of care first and Medicaid pays only what it doesn't cover, so Medicaid wouldn't pay while their income is higher. Ask the Medicaid agency when care costs rise.

  6. Are their countable savings and assets (not counting the home, one car, personal belongings, a prepaid funeral) under about $130,000 (2026 figure)?

    For a couple who are both applying: about $195,000 (2026 figure).

    If yes: Assets pass.

    If no: They'd need to spend down first, on things that are allowed, before Medicaid pays. See What is allowed instead. What is allowed instead

  7. Are they married, with a spouse who will keep living at home?

    If yes: That doesn't disqualify them. The spouse at home can keep up to about $162,660 (2026 figure) of the couple's countable assets and an income allowance that can bring their own income up to about $4,067 a month (2026 figure); the asset limit applies to the rest. Spouse's share calculator for California

    If no: The single-person limits apply.

  8. Have they given away money or property, or sold anything for less than it's worth, in the last 30 months (California's look-back)?

    If yes: Gifts and below-value sales in the look-back delay nursing-home Medicaid by a penalty period, which starts only once they're otherwise eligible. Giving away $50,000 in California ≈ 3.46 months without nursing-home coverage ($50,000 ÷ $14,440 a month). The penalty can be waited out, or cut if the gift is returned. Common mistakes #1

    If no: No transfer penalty. Keep the statements: the state checks the whole look-back.

  9. Do they own a home with more than California's cap in equity, with no spouse, or child under 21, blind or disabled, living there?

    California's home equity cap isn't a single published dollar figure, so this answer won't decide the result. Answer No if they don't own a home.

    If yes: They may be ineligible until the equity is below the cap (for example through a reverse mortgage, a home-equity loan or a sale).

    If no: The home doesn't stand in the way (estate recovery may still reach it after death).

Not legal advice. Figures are for 2026. The state makes the final decision: California Department of Health Care Services (DHCS); eligibility administered by county social services agencies. The requirements in full: Qualifying for Medicaid in California.

Start with these

Asset limit returned in 2026 and is scheduled to drop to $21,000 in July 2027

After two years with no asset test, Medi-Cal (aged/disabled/LTC and MSPs) counts assets again from 1/1/2026 at $130,000 single + $65,000 per extra person. The statute authorizing that level goes inoperative July 1, 2027, and the June 2026 budget lowers the limit to $21,000 (one person; ~$31,000 for two per DHCS FAQ snippets), applied at each member's renewal. Families who planned around $130,000 must re-plan before mid-2027; home and one car stay exempt.

Verified source
Where this comes from

Welf. & Inst. Code § 14005.62(e)

This section shall become inoperative on July 1, 2027, and, as of January 1, 2028, is repealed.

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. $21,000 figure from CalMatters (Oct 2026): 'state leaders approved a budget that will lower the asset limit for low-income seniors and people with disabilities to $21,000 to qualify for Medi-Cal, starting in July 2027.' The replacement statute section was not located/fetched; $31,000 couple figure seen only in DHCS FAQ search snippets.

California's penalty clock starts on the transfer date - and caps at 30 months

Unlike most states (penalty starts when you are otherwise eligible and in care), California starts the period of ineligibility in the month of the gift and caps it at 30 months. A gift made long enough before nursing-home entry can have its penalty fully expire. Conversely, a gift right before entry is penalized month-for-month at the APPR. Penalties apply only to nursing-facility care, not HCBS waivers.

Verified sourcearchived copy of official page, 2026-02-27
Where this comes from

DHCS ACWDL 25-18

would run from August 1, 2026 (the month the disqualifying transfer was made) through the end of December 2026 (the end of the 5th month)

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Example 4 of ACWDL 25-18; cap: 'The maximum POI is 30 months from the date of the transfer'.

Look-back is short now but grows monthly to 30 months by July 2028

Transfers made 1/1/2024-12/31/2025 are never penalized. For someone entering care in 2026 the look-back covers only 2026 months (plus a few late-2023 months early in the year); it lengthens one month at a time until it reaches the full 30 months in July 2028. Gifts made now will be inside the window later. Keep receipts for all 2026+ transfers.

Verified source
Where this comes from
Transfers made on or after January 1, 2026, may cause a penalty that delays your coverage.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Phase-in chart from HCA practice tip (DHCS chart reproduced).

Small gifts under one month of nursing-home cost are not penalized

California does not impose partial-month penalties: total transfers worth less than the Average Private Pay Rate (about $14,440 in 2026; $13,656 in 2025) produce no penalty. Above that, months = value / APPR, rounded down.

Verified sourcearchived copy of official page, 2026-05-14
Where this comes from

DHCS ACWDL 26-03; ACWDL 25-18

the 2026 Statewide Average Private Pay Rate (APPR) for nursing facility services (NFS) of $14,440.

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

No-partial-month rule from ACWDL 25-18: 'as no partial month POI are imposed'.

Estate recovery only reaches the probate estate - a living trust or TOD deed defeats it

For deaths on/after 1/1/2017, Medi-Cal can only claim against assets passing through probate, only for federally required services (nursing home/LTC for 55+), never while a spouse/RDP, minor or disabled child survives, and can waive for a modest-value home or hardship. Putting the home in a revocable trust or recording a revocable transfer-on-death deed keeps it out of probate. Don't deed the house to children outright (loses rights, capital-gains basis step-up).

Verified source
Where this comes from

Welf. & Inst. Code § 14009.5(g)

shall apply only to individuals who die on or after January 1, 2017.

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02.

Don't let the county add the healthy spouse to the application

Spousal impoverishment protection (community spouse keeps up to $162,660 in 2026 on top of the ill spouse's $130,000) only applies when just the institutionalized spouse applies. Counties sometimes 'automatically' add the community spouse, which makes each spouse face the $130,000 limit. Ask the county to withdraw the healthy spouse. After approval, retitle joint accounts within the ~90-day window.

LikelySecondary source
Where this comes from
Sometimes counties will ‘automatically’ add the community spouse to an application.

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

Health Consumer Alliance (legal-aid coalition) practice tip, updated 3/20/2026; cites DHCS ACWDLs 25-14, 25-18, 26-02. DHCS site (dhcs.ca.gov) blocks automated fetching (Incapsula bot wall), so the ACWDLs themselves could not be retrieved.

Check 'intends to return home' - it keeps the house exempt indefinitely

The home stays exempt no matter how long the stay if the application says the resident intends to return; counties may not require proof. A mistaken 'no' can be corrected. The only exception is the separate six-month home-maintenance income deduction, which may require proof of likely return within six months.

LikelySecondary source
Where this comes from
Counties are not allowed to require any kind of verification of a Medi-Cal member’s intent or ability to return home after they enter a long-term care facility.

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

Health Consumer Alliance (legal-aid coalition) practice tip, updated 3/20/2026; cites DHCS ACWDLs 25-14, 25-18, 26-02. DHCS site (dhcs.ca.gov) blocks automated fetching (Incapsula bot wall), so the ACWDLs themselves could not be retrieved.

Home-equity cap coming in 2028

California has never capped home equity for Medi-Cal LTC, but federal H.R. 1 imposes a $1,000,000 (not inflation-indexed) cap starting January 1, 2028 for nursing-home and HCBS coverage. High-equity Bay Area/LA homeowners should plan (e.g., reverse mortgage, spouse/disabled-child exceptions).

LikelySecondary source
Where this comes from
Effective January 1, 2028, OBBBA sets a permanent cap of $1 million in equity for non-agricultural homes

Source page · Secondary source · as of 2028 · retrieved 2026-11-04

National Health Law Program fact sheet, Aug 2025.

Medigap: use the 60-day birthday window to switch without underwriting

California lets Medigap holders switch to a plan with equal or lesser benefits from any company for 60+ days starting on their birthday each year, with no health questions. Outside that window (and the initial/age-65 and event-based windows) insurers can underwrite and refuse. Medicare-disabled under-65s also get an open-enrollment right.

Verified source
Where this comes from

Cal. Ins. Code § 10192.11(h)

that offers benefits equal to or lesser than those provided by the previous coverage

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02.

Ground-ambulance protection covers state-regulated plans and the uninsured - not every plan

Since 2024 (AB 716), people in California-regulated health plans owe only in-network cost-sharing to an out-of-network ground ambulance, and uninsured/self-pay patients cannot be charged more than the greater of Medi-Cal or Medicare rates. Self-funded employer plans (ERISA) are generally outside state law; check your plan type and dispute bills that exceed these caps.

Verified source
Where this comes from

Health & Safety Code § 1371.56

require an enrollee who receives covered services from a noncontracting ground ambulance provider

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. ERISA caveat is general preemption law, not from the fetched page.

Personal needs allowance is only $35/month

A nursing-home Medi-Cal resident keeps just $35/month (plus health-insurance premiums); everything else is share of cost paid to the facility. Budget for clothing, phone, haircuts from family funds, or consider an irrevocable prepaid burial plan and other exempt purchases before applying.

Verified source
Where this comes from

22 CCR § 50605

Thirty-five dollars for personal and incidental needs

Source page · Official regulation · as of 2026 · retrieved 2026-11-04

At a glance

Nursing-home Medicaid income limitNot confirmedVerified sourceMiller trust (QIT) needed above the limitNoVerified sourceAsset limit (single)$130,000Verified sourceLook-back30 months (nursing home)Verified sourcePenalty divisor$14,440/monthVerified sourcearchived copy of official page, 2026-05-14Estate recovery reachProbate estate onlyVerified sourceAdult children can be liable (filial law)Yes – rarely enforcedLikelySurprise ground-ambulance bill protectionYesVerified sourceMedigap birthday/anniversary switch ruleYesVerified source

Calculators for California Compare states

Qualifying for Medicaid in California

For Medicaid to pay for a nursing home in California: all of these must be met. Federal law sets the rules; the figures under each one are California's.

  1. Age 65 or older, blind, or disabled

    Long-term-care Medicaid for adults outside the under-65 expansion group is for people who are 65 or older, blind, or disabled (blindness and disability use the Social Security definitions).

    42 U.S.C. 1382c(a)(1)(A)Verified source
    Where this comes from

    42 U.S.C. 1382c(a)(1)(A)

    the term "aged, blind, or disabled individual" means an individual who— (A) is 65 years of age or older, is blind (as determined under paragraph (2)), or is disabled (as determined under paragraph (3))

    Source page · Official code · as of current statute · retrieved 2026-11-04

    Medicaid.gov, Eligibility PolicyVerified source
    Where this comes from

    Medicaid.gov, Eligibility Policy

    Medicaid eligibility for individuals 65 and older or who have blindness or a disability is generally determined using the income methodologies of the SSI program administered by the Social Security Administration

    Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

  2. Lives in the state

    Apply in the state where the person lives. A state cannot turn someone away for not having a permanent or fixed address there. Moving a parent into a nursing home in another state generally means applying in that state.

    42 CFR 435.403(a)Verified source
    Where this comes from

    42 CFR 435.403(a)

    The agency must provide Medicaid to eligible residents of the State, including residents who are absent from the State.

    Source page · Official regulation · as of current regulation · retrieved 2026-11-04

    Text read through the eCFR API (ecfr.gov), current as of 2026-11-02.

    Medicaid.gov, Eligibility PolicyVerified source
    Where this comes from

    Medicaid.gov, Eligibility Policy

    Medicaid beneficiaries generally must be residents of the state in which they are receiving Medicaid.

    Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

  3. U.S. citizen or qualified immigrant

    The person must be a U.S. citizen or national, or a qualified non-citizen such as a lawful permanent resident (some qualified non-citizens wait 5 years). People already on Medicare or SSI don't have to re-prove citizenship.

    Medicaid.gov, Eligibility PolicyVerified source
    Where this comes from

    Medicaid.gov, Eligibility Policy

    They must be either citizens of the United States or certain qualified non-citizens, such as lawful permanent residents.

    Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

    42 CFR 435.406(a)(1)(iii)(B)Verified source
    Where this comes from

    42 CFR 435.406(a)(1)(iii)(B)

    (B) Individuals entitled to or enrolled in any part of Medicare.

    Source page · Official regulation · as of current regulation · retrieved 2026-11-04

    Text read through the eCFR API (ecfr.gov), current as of 2026-11-02.

  4. Social Security number

    The application must include the person's Social Security number (the agency helps apply for one if needed, and narrow religious and non-work exceptions exist).

    42 CFR 435.910(a)Verified source
    Where this comes from

    42 CFR 435.910(a)

    the agency must require, as a condition of eligibility, that each individual (including children) seeking Medicaid furnish each of his or her Social Security numbers (SSN).

    Source page · Official regulation · as of current regulation · retrieved 2026-11-04

    Text read through the eCFR API (ecfr.gov), current as of 2026-11-02.

  5. An application, by the person or someone acting for them

    A family member, an authorized representative, or someone acting responsibly for a person who can't apply can file. States can be applied to online, by phone, by mail or in person, and may use extra long-term-care forms.

    42 CFR 435.907(a)Verified source
    Where this comes from

    42 CFR 435.907(a)

    the agency must accept an application from the applicant, an adult who is in the applicant's household, as defined in § 435.603(f), or family, as defined in section 36B(d)(1) of the Code, an authorized representative, or if the applicant is a minor or incapacitated, someone acting responsibly for the applicant

    Source page · Official regulation · as of current regulation · retrieved 2026-11-04

    Text read through the eCFR API (ecfr.gov), current as of 2026-11-02.

  6. Needs nursing-home level of care (the state decides)

    Being old and low-income isn't enough: the state must find that the person medically or functionally needs nursing-facility care, using its own level-of-care criteria. People with serious mental illness or an intellectual disability also go through a pre-admission screening (PASRR).

    Medicaid.gov, Nursing FacilitiesVerified source
    Where this comes from

    Medicaid.gov, Nursing Facilities

    Need for nursing facility services is defined by states, all of whom have established NF level of care criteria.

    Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

  7. Passes BOTH an income test and an asset test

    Long-term-care Medicaid has two money tests: monthly income under the state's limit (or a Miller trust / spend-down where the state allows it) and countable assets under the state's limit. Passing one isn't enough.

    42 U.S.C. 1396a(a)(10)(A)(ii)(V)Verified source
    Where this comes from

    42 U.S.C. 1396a(a)(10)(A)(ii)(V)

    who are in a medical institution for a period of not less than 30 consecutive days (with eligibility by reason of this subclause beginning on the first day of such period), who meet the resource requirements of the appropriate State plan described in clause (i) or the supplemental security income program, and whose income does not exceed a separate income standard established by the State

    Source page · Official code · as of current statute · retrieved 2026-11-04

    In California

    How income is treatedVerified source
    Spend-down (medically needy)
    Where this comes from
    There is no income limit, but most of your income will be used to pay the nursing facility where you reside.

    Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

    California has no income cap for nursing-home Medi-Cal; excess income becomes a monthly 'share of cost' paid to the facility. Source is LA County DPSS (county Medi-Cal eligibility agency).

    Income limitVerified source
    Not confirmed
    Where this comes from
    There is no income limit, but most of your income will be used to pay the nursing facility where you reside.

    Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

    No income cap (value null = no limit). Resident keeps $35/month personal needs plus health insurance premiums; the rest is share of cost.

    Miller trust (QIT) needed above the limitVerified source
    No
    Where this comes from
    There is no income limit, but most of your income will be used to pay the nursing facility where you reside.

    Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

    No Qualified Income Trust needed because there is no income cap.

    Asset limit, singleVerified source
    $130,000
    Where this comes from

    Welf. & Inst. Code § 14005.62(a)(1); DHCS ACWDL 25-14

    $130,000

    Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

    Reinstated 1/1/2026 after no asset test in 2024-2025. Quote is the table cell for '1 person' under the DPSS heading 'Household Asset Limits as of January 1, 2026'. Scheduled to drop to $21,000 (one person) on July 1, 2027 - see gotchas.

    Asset limit, couple both applyingVerified source
    $195,000
    Where this comes from
    $195,000

    Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

    $130,000 + $65,000 per additional household member (up to 10). If only one spouse needs long-term care, spousal impoverishment rules apply instead (each unit evaluated separately; see csraMax). Quote is the DPSS table cell for '2 people'.

    Miller trust check for California

  8. No gifts in the 60-month look-back (or the penalty is served)

    The state reviews transfers made in the 60 months before the person is both in a nursing home and has applied. Gifts and below-value sales in that window cause a penalty period with no long-term-care coverage.

    42 U.S.C. 1396p(c)(1)(B)(i)Verified source
    Where this comes from

    42 U.S.C. 1396p(c)(1)(B)(i)

    in the case of any other disposal of assets made on or after February 8, 2006, 60 months) before the date specified in clause (ii).

    Source page · Official code · as of current statute · retrieved 2026-11-04

    In California

    Look-backVerified source
    Nursing home
    30 months
    Counts transfers from
    2026-01-01
    Where this comes from
    Medi-Cal will look at any assets you gave away in the 30 months before you entered the facility.

    Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

    California uses 30 months, not the federal 60. Phase-in: transfers 1/2024-12/2025 are never penalized and transfers before 1/1/2026 not counted ('Transfers made before January 1, 2026, will not be counted.'); per HCA/DHCS chart, the effective look-back is ~6-11 months during 2026 and reaches the full 30 months in July 2028.

    Penalty divisorVerified sourcearchived copy of official page, 2026-05-14
    $14,440/month
    Where this comes from

    DHCS ACWDL 26-03 (Feb. 9, 2026); 22 CCR 50408, 50411

    The purpose of this All County Welfare Directors Letter (ACWDL) is to provide counties with the 2026 Statewide Average Private Pay Rate (APPR) for nursing facility services (NFS) of $14,440.

    Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

    Applies only when 'The application date or date of institutionalization occurs on or after January 1, 2026'. Letter also: 'no period of ineligibility shall be calculated for any disqualifying transfers made between January 1, 2024, and December 31, 2025, regardless of the application or institutionalization date.' 2025 APPR was $13,656 (per earlier research).

    Gift penalty calculator for California

  9. Home equity under the cap

    The home is usually not counted, but a person whose equity in the home is over the state's cap can't get nursing-home or other long-term-care Medicaid, unless a spouse or a child under 21 or blind/disabled lives there. Federal cap: $500,000 to $750,000 in 1996 dollars, indexed (2026: $752,000 to $1,130,000).

    42 U.S.C. 1396p(f)(1)(A)Verified source
    Where this comes from

    42 U.S.C. 1396p(f)(1)(A)

    the individual shall not be eligible for such assistance if the individual's equity interest in the individual's home exceeds $500,000.

    Source page · Official code · as of current statute · retrieved 2026-11-04

    In California

    Home equity limitLikelySecondary source
    Not confirmed
    Where this comes from
    The home equity limit does not apply in California yet.

    Source page · Secondary source · as of 2026 · retrieved 2026-11-04

    California has not applied a home-equity cap (NHeLP Aug 2025: 'California has never imposed a limit on home equity for eligibility for long-term care services'). H.R. 1 (OBBBA) imposes a $1,000,000 non-indexed cap effective January 1, 2028. Federal 2026 range is $752,000-$1,130,000 (CMS CIB 12/9/2025) but CA does not apply it per these sources. Could not fetch DHCS confirmation.

After approval, and care at home

Common mistakes

These are the mistakes that most often cost families coverage. They apply in every state.

1. Moving money out of the account or giving it to the children

You can't simply give money away (or move it to a child's account) to get under the asset limit. Any transfer for less than fair market value within the 60-month look-back makes the person ineligible for nursing-home and waiver coverage for a penalty period: the total given away divided by the state's penalty divisor (its average monthly private-pay nursing-home cost).

Worked example for California

Giving away $50,000 in California ≈ 3.46 months without nursing-home coverage

$50,000 ÷ $14,440 a month (the penalty divisor). The penalty starts only once the person is otherwise eligible (see the next mistake).

California penalty divisorVerified sourcearchived copy of official page, 2026-05-14
Where this comes from

DHCS ACWDL 26-03 (Feb. 9, 2026); 22 CCR 50408, 50411

The purpose of this All County Welfare Directors Letter (ACWDL) is to provide counties with the 2026 Statewide Average Private Pay Rate (APPR) for nursing facility services (NFS) of $14,440.

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Applies only when 'The application date or date of institutionalization occurs on or after January 1, 2026'. Letter also: 'no period of ineligibility shall be calculated for any disqualifying transfers made between January 1, 2024, and December 31, 2025, regardless of the application or institutionalization date.' 2025 APPR was $13,656 (per earlier research).

Gift penalty calculator for California

42 U.S.C. 1396p(c)(1)(A)Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(A)

disposes of assets for less than fair market value on or after the look-back date specified in subparagraph (B)(i), the individual is ineligible for medical assistance

Source page · Official code · as of current statute · retrieved 2026-11-04

42 U.S.C. 1396p(c)(1)(E)(i)Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(E)(i)

the total, cumulative uncompensated value of all assets transferred by the individual (or individual's spouse) on or after the look-back date specified in subparagraph (B)(i), divided by (II) the average monthly cost to a private patient of nursing facility services in the State

Source page · Official code · as of current statute · retrieved 2026-11-04

2. Giving money away first, then spending the rest down

The penalty clock doesn't start on the day of the gift. It starts only when the person is in a nursing home (or needs that level of care), has spent down to the asset limit, has applied, and would be approved but for the penalty. So giving money away and then spending down is the worst order: the penalty starts exactly when there is no money left to pay the nursing home.

42 U.S.C. 1396p(c)(1)(D)(ii)Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(D)(ii)

the date on which the individual is eligible for medical assistance under the State plan and would otherwise be receiving institutional level care described in subparagraph (C) based on an approved application for such care but for the application of the penalty period, whichever is later

Source page · Official code · as of current statute · retrieved 2026-11-04

3. Adding a child to the bank account

Putting a child's name on the account doesn't protect the money: the whole joint account is generally counted as the applicant's. And when the child (or anyone) takes money out, that can count as a transfer by the applicant, with a penalty.

SSA POMS SI 01140.205C.2Likely
Where this comes from

SSA POMS SI 01140.205C.2

When a claimant or recipient co-owns an account with someone who is not eligible for SSI benefits, we assume that all the funds in the account belong to the SSI claimant or recipient.

Source page · Agency guidance · as of 2023-12-27 · retrieved 2026-11-04

SSI rule. Medicaid for people 65+, blind or disabled generally uses SSI income and resource methods (42 CFR 435.601), but 209(b) states and states with less restrictive methods can differ: check the state.

42 U.S.C. 1396p(c)(3)Verified source
Where this comes from

42 U.S.C. 1396p(c)(3)

the asset (or the affected portion of such asset) shall be considered to be transferred by such individual when any action is taken, either by such individual or by any other person, that reduces or eliminates such individual's ownership or control of such asset.

Source page · Official code · as of current statute · retrieved 2026-11-04

4. Paying family for care without a written agreement

Relatives can be paid for caregiving, but care given for free is presumed to have been free. Paying a child afterwards for past care, or paying without a written agreement made at the time the care was given, is treated as a gift. Put a written agreement in place before the care starts, pay a fair market rate as the care is given, and keep records.

CMS State Medicaid Manual § 3258.1.A.1 (Rev. 64)Verified source
Where this comes from

CMS State Medicaid Manual § 3258.1.A.1 (Rev. 64)

Also, while relatives and family members legitimately can be paid for care they provide to the individual, HCFA presumes that services provided for free at the time were intended to be provided without compensation. Thus, a transfer to a relative for care provided for free in the past is a transfer of assets for less than fair market value. However, an individual can rebut this presumption with tangible evidence that is acceptable to the State. For example, you may require that a payback arrangement had been agreed to in writing at the time services were provided.

Source page · Agency guidance · as of 1994-11 · retrieved 2026-11-04

CMS State Medicaid Manual, Chapter 3 (download p45_03.zip, file "sm 03 3 325 to 3259.8.doc"), Transmittal 64, November 1994. Still the posted federal manual; many states have since adopted stricter written personal-care-agreement rules, so check the state.

5. Giving away or underselling the home

Deeding the house to the kids, or selling it to them for less than it's worth, is a transfer with a penalty. The only home transfers that are allowed without penalty are to: a spouse; a child under 21 or a blind or disabled child; a sibling with an equity interest who lived there at least a year before the move to a nursing home; or a son or daughter who lived there at least two years and whose care kept the parent out of a nursing home.

42 U.S.C. 1396p(c)(2)(A)Verified source
Where this comes from

42 U.S.C. 1396p(c)(2)(A)

(A) the assets transferred were a home and title to the home was transferred to— (i) the spouse of such individual; (ii) a child of such individual who (I) is under age 21, or (II) (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or permanently and totally disabled

Source page · Official code · as of current statute · retrieved 2026-11-04

42 U.S.C. 1396p(c)(2)(A)(iv)Verified source
Where this comes from

42 U.S.C. 1396p(c)(2)(A)(iv)

a son or daughter of such individual (other than a child described in clause (ii)) who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual, and who (as determined by the State) provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility

Source page · Official code · as of current statute · retrieved 2026-11-04

6. Annuities, promissory notes and life estates that don't meet the rules

Buying an annuity, lending money to family on a note, or buying a life estate in a child's home all count as gifts unless they meet strict federal rules: annuities must name the state as remainder beneficiary and be irrevocable, non-assignable, actuarially sound and paid in equal amounts; notes must be actuarially sound, paid in equal amounts and not forgiven at death; a life-estate buyer must live in the home for at least a year after buying.

42 U.S.C. 1396p(c)(1)(F)Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(F)

the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless— (i) the State is named as the remainder beneficiary in the first position

Source page · Official code · as of current statute · retrieved 2026-11-04

42 U.S.C. 1396p(c)(1)(I)Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(I)

the term "assets" includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— (i) has a repayment term that is actuarially sound

Source page · Official code · as of current statute · retrieved 2026-11-04

42 U.S.C. 1396p(c)(1)(J)Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(J)

the term "assets" includes the purchase of a life estate interest in another individual's home unless the purchaser resides in the home for a period of at least 1 year after the date of the purchase.

Source page · Official code · as of current statute · retrieved 2026-11-04

7. Forgetting estate recovery after death

After a person who got Medicaid at 55 or older dies, the state must try to recover what it paid for nursing-home and home-care services from the estate, usually the house. Recovery waits while a spouse, a child under 21 or a blind or disabled child survives. Some states also reach assets that skip probate (joint accounts, life estates, living trusts).

42 U.S.C. 1396p(b)(4)(B)Verified source
Where this comes from

42 U.S.C. 1396p(b)(4)(B)

any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.

Source page · Official code · as of current statute · retrieved 2026-11-04

Medicaid.gov, Estate RecoveryVerified source
Where this comes from

Medicaid.gov, Estate Recovery

For individuals age 55 or older, states are required to seek recovery of payments from the individual's estate for nursing facility services, home and community-based services, and related hospital and prescription drug services.

Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

8. Missing records for the look-back

States typically ask for up to five years (60 months) of statements for every account, including closed ones. Money that left an account for less than fair value is presumed to be a penalized transfer unless you can show what it was for, so withdrawals you can't explain can be treated as gifts. Keep receipts and statements from the start.

Oklahoma Human Services, Long-Term CareLikely
Where this comes from

Oklahoma Human Services, Long-Term Care

We will need the last sixty (60) months of statements on all accounts held in the past 60 months. If any asset has been sold, traded, or given away within the last 60 months prior to entry into the nursing home and application for Medicaid, we will require documentation of the transfer.

Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

A state example, not a federal rule: we found no federal source setting how many months of statements states must request. Other states ask similar.

Ohio Adm.Code 5160:1-6-06(B)Likely
Where this comes from

Ohio Adm.Code 5160:1-6-06(B)

any such transfer will be presumed an improper transfer and will result in a restricted medicaid coverage period (RMCP)

Source page · Official regulation · as of 2025-10-01 · retrieved 2026-11-04

A state example of how agencies treat transfers they can't verify.

42 U.S.C. 1396p(c)(2)(C)Verified source
Where this comes from

42 U.S.C. 1396p(c)(2)(C)

a satisfactory showing is made to the State (in accordance with regulations promulgated by the Secretary) that (i) the individual intended to dispose of the assets either at fair market value, or for other valuable consideration, (ii) the assets were transferred exclusively for a purpose other than to qualify for medical assistance

Source page · Official code · as of current statute · retrieved 2026-11-04

In California specifically

Details and sources are in the cards at the top of this page.

What is allowed instead

Spend at fair market value, on the person who needs care

Money spent on the applicant and for full value is not a gift: paying the nursing home, paying debts, buying things the applicant needs. Keep receipts.

42 U.S.C. 1396p(c)(2)(C)Verified source
Where this comes from

42 U.S.C. 1396p(c)(2)(C)

the individual intended to dispose of the assets either at fair market value, or for other valuable consideration

Source page · Official code · as of current statute · retrieved 2026-11-04

Pay bills and care costs, prepay the funeral

Over-limit money can go to the cost of care, to bills the person owes, and to prepaying their funeral, as long as nothing is given away or sold for less than it's worth.

Maryland Department of Health, Some Questions and Answers about Financial Eligibility (nursing home)Likely
Where this comes from

Maryland Department of Health, Some Questions and Answers about Financial Eligibility (nursing home)

Resources over the $2,500 limit may be used in several ways as long as they are not given away or exchanged for something of lesser value. For example, you may use your excess resources to pay for the cost of care in the nursing home, to pay other bills that you may have, or to prepay your funeral expenses.

Source page · Agency guidance · as of 2006 · retrieved 2026-11-04

A state example (2006 publication; the $2,500 figure is Maryland's and dated). The principle (spending for fair value) is federal: 42 U.S.C. 1396p(c)(2)(C).

An irrevocable prepaid funeral

A prepaid funeral contract that can't be cancelled or sold doesn't count as an asset (a revocable one does, above small burial-fund limits). States set the maximum that can be made irrevocable.

SSA POMS SI 01130.420B.2Likely
Where this comes from

SSA POMS SI 01130.420B.2

If a burial contract cannot be revoked and cannot be sold without significant hardship, it is not a resource.

Source page · Agency guidance · as of 2011-06-17 · retrieved 2026-11-04

SSI rule. Medicaid for people 65+, blind or disabled generally uses SSI income and resource methods (42 CFR 435.601), but 209(b) states and states with less restrictive methods can differ: check the state.

Things that don't count: the home, one car, household goods

The home the person lives in (up to the equity cap), one car used for transportation, and household goods are excluded. Spending countable cash at fair value on these (for example, repairs or accessibility changes to the home the person lives in, or replacing the one car) generally turns it into an excluded asset. Check the state's rules before a large purchase.

20 CFR 416.1210(a)-(c)Likely
Where this comes from

20 CFR 416.1210(a)-(c)

(a) The home (including the land appertaining thereto) to the extent its value does not exceed the amount set forth in § 416.1212; (b) Household goods and personal effects as defined in § 416.1216; (c) An automobile, if used for transportation, as provided in § 416.1218

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Text read through the eCFR API (ecfr.gov), current as of 2026-11-02. SSI rule. Medicaid for people 65+, blind or disabled generally uses SSI income and resource methods (42 CFR 435.601), but 209(b) states and states with less restrictive methods can differ: check the state.

Pay medical bills

Unpaid and current medical bills the person owes can use up excess resources. Some states count them directly against the excess.

New York State Department of Health, LDSS-4321 attachment (11 ADM-4)Likely
Where this comes from

New York State Department of Health, LDSS-4321 attachment (11 ADM-4)

you may be eligible for Medicaid coverage if you have medical bills that are equal to or higher than the amount of your excess resources, or if you spend excess resources on certain expenses set aside for your and your spouse’s burial.

Source page · Agency form · as of 2011-07 · retrieved 2026-11-04

A state example (New York notice language, 2011).

Transfers to a spouse

Moving assets to a spouse (or to someone else for the spouse's sole benefit) is not penalized. It doesn't hide them at application, because both spouses' assets are counted together, but after approval the at-home spouse can keep the protected share (CSRA).

42 U.S.C. 1396p(c)(2)(B)(i)Verified source
Where this comes from

42 U.S.C. 1396p(c)(2)(B)(i)

were transferred to the individual's spouse or to another for the sole benefit of the individual's spouse

Source page · Official code · as of current statute · retrieved 2026-11-04

42 U.S.C. 1396r-5(f)(1)Verified source
Where this comes from

42 U.S.C. 1396r-5(f)(1)

An institutionalized spouse may, without regard to section 1396p(c)(1) of this title, transfer an amount equal to the community spouse resource allowance (as defined in paragraph (2)), but only to the extent the resources of the institutionalized spouse are transferred to (or for the sole benefit of) the community spouse.

Source page · Official code · as of current statute · retrieved 2026-11-04

Who to call

Eligibility figures and notes

How income is treatedVerified source
Spend-down (medically needy)
Where this comes from
There is no income limit, but most of your income will be used to pay the nursing facility where you reside.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

California has no income cap for nursing-home Medi-Cal; excess income becomes a monthly 'share of cost' paid to the facility. Source is LA County DPSS (county Medi-Cal eligibility agency).

Income limitVerified source
Not confirmed
Where this comes from
There is no income limit, but most of your income will be used to pay the nursing facility where you reside.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

No income cap (value null = no limit). Resident keeps $35/month personal needs plus health insurance premiums; the rest is share of cost.

Miller trust requiredVerified source
No
Where this comes from
There is no income limit, but most of your income will be used to pay the nursing facility where you reside.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

No Qualified Income Trust needed because there is no income cap.

Asset limit, singleVerified source
$130,000
Where this comes from

Welf. & Inst. Code § 14005.62(a)(1); DHCS ACWDL 25-14

$130,000

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Reinstated 1/1/2026 after no asset test in 2024-2025. Quote is the table cell for '1 person' under the DPSS heading 'Household Asset Limits as of January 1, 2026'. Scheduled to drop to $21,000 (one person) on July 1, 2027 - see gotchas.

Asset limit, couple both applyingVerified source
$195,000
Where this comes from
$195,000

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

$130,000 + $65,000 per additional household member (up to 10). If only one spouse needs long-term care, spousal impoverishment rules apply instead (each unit evaluated separately; see csraMax). Quote is the DPSS table cell for '2 people'.

Personal needs allowance (what the resident keeps)Verified source
$35/month
Where this comes from

22 CCR § 50605; Welf. & Inst. Code § 14005.12(d)(1)

Thirty-five dollars for personal and incidental needs

Source page · Official regulation · as of 2026 · retrieved 2026-11-04

Unchanged for decades. W&I 14005.12 says 'not less than thirty-five dollars ($35) per month'. Bill AB 1649 (2025-26) to raise it was reported in committee as of Feb 2026; status not verified.

Home equity limitLikelySecondary source
Not confirmed
Where this comes from
The home equity limit does not apply in California yet.

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

California has not applied a home-equity cap (NHeLP Aug 2025: 'California has never imposed a limit on home equity for eligibility for long-term care services'). H.R. 1 (OBBBA) imposes a $1,000,000 non-indexed cap effective January 1, 2028. Federal 2026 range is $752,000-$1,130,000 (CMS CIB 12/9/2025) but CA does not apply it per these sources. Could not fetch DHCS confirmation.

Keeping the home exemptLikelySecondary source
Principal residence exempt while the applicant lives there, intends to return (self-declared on the application, counties may not demand verification), or a spouse/dependent relative lives in it. Errors on the 'intend to return' checkbox can be corrected later.
Where this comes from

ACWDL 95-48; 22 CCR 50425

If the applicant (or someone who is helping the applicant fill out the application) checks “yes” to say that the person intends to return home, then the person’s home remains an exempt asset no matter how long they stay in the facility.

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

Health Consumer Alliance (legal-aid coalition) practice tip, updated 3/20/2026; cites DHCS ACWDLs 25-14, 25-18, 26-02. DHCS site (dhcs.ca.gov) blocks automated fetching (Incapsula bot wall), so the ACWDLs themselves could not be retrieved.

ApplyingVerified sourcearchived copy of official page, 2026-02-27
Apply through the county social services office. Since 1/1/2026 applicants must report and verify assets; existing members are tested at next annual renewal. Spousal joint assets can be retitled to the community spouse within ~90 days (through end of the month of the 90th day) after the approval notice.
Where this comes from

DHCS ACWDL 25-14 (June 30, 2025); ACWDL 26-02

Individuals applying for Medi-Cal benefits under the affected Non-MAGI programs with an application date after January 1, 2026, will be required to report asset information and provide verification of their assets as part of their eligibility determination.

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Existing members are tested 'At their next annual renewal' or at a change-in-circumstance redetermination. CSRA transfer window from ACWDL 26-02: ends 'on the last day of the month in which the 90th day falls, from the date the approval notice of action (NOA) is mailed'.

Protecting the spouse at home

How the spouse's asset share is setLikelyarchived copy of official page, 2026-05-14
100% state (flat federal maximum for all community spouses)
Where this comes from

DHCS ACWDL 26-02

Starting January 1, 2026, the CSRA is $162,660.00

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

DHCS states a single CSRA figure rather than one-half of the couple's assets; method inferred from that. CSRA transfer period: 'The CSRA transfer period begins with the initial month of eligibility and ends on the last day of the month in which the 90th day falls, from the date the approval notice of action (NOA) is mailed'.

Spouse keeps at least (CSRA min)Likelyarchived copy of official page, 2026-05-14
Not confirmed
Where this comes from

DHCS ACWDL 26-02

Starting January 1, 2026, the CSRA is $162,660.00

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

DHCS publishes one CSRA figure (the federal maximum) and no separate minimum, so there is effectively no lower minimum. Federal 2026 minimum is $32,532 but is not used.

Spouse keeps at most (CSRA max)Verified sourcearchived copy of official page, 2026-05-14
$162,660
Where this comes from

DHCS ACWDL 26-02 (Jan. 28, 2026)

Starting January 1, 2026, the CSRA is $162,660.00

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

DHCS did not publish a 2025 CSRA because property limits were eliminated 2024-2025. Applies only to cases newly determined under spousal impoverishment rules from 1/1/2026.

Spouse's monthly income floor (MMMNA min)Verified sourcearchived copy of official page, 2026-05-14
$4,067/month
Where this comes from

DHCS ACWDL 26-02 (Jan. 28, 2026)

Effective January 1, 2026, the MMMNA is $4,067 per month

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

California uses a single MMMNA equal to the federal maximum (rounded); 2025 was $3,948 ('The MMMNA amount effective January 1, 2025, through December 31, 2025, was $3,948.').

Spouse's monthly income cap (MMMNA max)Verified sourcearchived copy of official page, 2026-05-14
$4,067/month
Where this comes from

DHCS ACWDL 26-02 (Jan. 28, 2026)

Effective January 1, 2026, the MMMNA is $4,067 per month

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Single figure (see mmmnaMin). Federal 2026 maximum is $4,066.50.

Gifts, the look-back and the penalty

Look-back periodVerified source
Nursing home
30 months
Counts transfers from
2026-01-01
Where this comes from
Medi-Cal will look at any assets you gave away in the 30 months before you entered the facility.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

California uses 30 months, not the federal 60. Phase-in: transfers 1/2024-12/2025 are never penalized and transfers before 1/1/2026 not counted ('Transfers made before January 1, 2026, will not be counted.'); per HCA/DHCS chart, the effective look-back is ~6-11 months during 2026 and reaches the full 30 months in July 2028.

Penalty divisorVerified sourcearchived copy of official page, 2026-05-14
$14,440/month
Where this comes from

DHCS ACWDL 26-03 (Feb. 9, 2026); 22 CCR 50408, 50411

The purpose of this All County Welfare Directors Letter (ACWDL) is to provide counties with the 2026 Statewide Average Private Pay Rate (APPR) for nursing facility services (NFS) of $14,440.

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Applies only when 'The application date or date of institutionalization occurs on or after January 1, 2026'. Letter also: 'no period of ineligibility shall be calculated for any disqualifying transfers made between January 1, 2024, and December 31, 2025, regardless of the application or institutionalization date.' 2025 APPR was $13,656 (per earlier research).

When the penalty startsVerified sourcearchived copy of official page, 2026-02-27
Month of transfer (not the date of application/eligibility). Penalty = value / APPR in whole months (no partial months), capped at 30 months from the transfer date. Penalties apply only to nursing-facility level of care, not community programs, and require DHCS approval and an undue-hardship review.
Where this comes from

DHCS ACWDL 25-18 (Oct. 9, 2025); ACWDL 90-01 § 50411.3

The maximum POI is 30 months from the date of the transfer (ACWDL 90-01, Section 50411.3).

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Example 4 in the letter: 'the CEW determines that the POI is 5 months long, as no partial month POI are imposed, and would run from August 1, 2026 (the month the disqualifying transfer was made) through the end of December 2026'. Also: 'The POI does not apply to Medi-Cal members enrolled in community-based Medi-Cal programs.' and 'The POI shall not be imposed without approval from the DHCS Medi-Cal Eligibility Division.'

Transfers that are not penalizedVerified sourcearchived copy of official page, 2026-02-27
Transfers while total countable assets are below the limit; transfers of exempt assets (incl. the home); any transfer 1/1/2024-12/31/2025; transfers shown to be for a purpose other than qualifying; transfers less than one month's APPR; to spouse/RDP; to a blind or disabled child of any age.
Where this comes from

DHCS ACWDL 25-18; WIC 14015, 14015.1(b); 22 CCR 50408, 50409

Counties do not need to follow up when electronic asset verification shows transfers under the average private pay rate (APPR) for nursing facility level of care, or when the individual was within the asset limits at the date of the transfer.

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Further quotes from ACWDL 25-18: 'transfers of exempt assets are not penalized (WIC Section 14015)'; 'Counties shall not request verification, review electronic asset verification information, or calculate any periods of ineligibility for transfers of assets made on or after January 1, 2024, through December 31, 2025'; transfers shown to be 'for reasons other than to establish eligibility' are not penalized; undue hardship (WIC 14015.1(b)) must be reviewed first. Spouse/RDP and blind/disabled-child exemptions are from 22 CCR 50408 per the Health Consumer Alliance practice tip (secondary), not restated in 25-18.

After death: estate recovery and liens

What the state can recover fromVerified source
Probate estate only
Where this comes from

Welf. & Inst. Code § 14009.5

all real and personal property and other assets in the individual's probate estate

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. Applies to deaths on or after January 1, 2017 ('shall apply only to individuals who die on or after January 1, 2017'). Recovery limited to services federally required (nursing facility; 55+ LTC/HCBS and related). Living trusts, TOD/beneficiary assets, joint tenancy pass outside probate and are not reachable.

LiensLikelySecondary source
No
Where this comes from
DHCS will never put a lien on a member’s home or attempt to recover the costs of care while the person is still alive.

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

Health Consumer Alliance (legal-aid coalition) practice tip, updated 3/20/2026; cites DHCS ACWDLs 25-14, 25-18, 26-02. DHCS site (dhcs.ca.gov) blocks automated fetching (Incapsula bot wall), so the ACWDLs themselves could not be retrieved.

Deferrals and hardship waiversVerified source
No claim if survived by spouse/RDP; deferral while a child under 21 or blind/disabled child survives; hardship waiver; waiver for 'homestead of modest value' (FMV <= 50% of county average home price). DHCS reportedly pursues recovery only if probate estate exceeds $208,850 personal / $69,625 real property (deaths on/after 4/1/2025).
Where this comes from

Welf. & Inst. Code § 14009.5(b)(2)(B)(i), (c)

waive its claim when the estate subject to recovery is a homestead of modest value.

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. Probate-threshold dollar figures come from the HCA practice tip (secondary).

NotesLikelySecondary source
Recovery claims are limited to the member's probate estate; ordinary estate planning (revocable living trust, TOD deed) defeats recovery. Asset-limit reinstatement did not change estate recovery.
Where this comes from
is unchanged and continues to apply

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

Justice in Aging FAQ (Nov 19, 2025).

Family liability

Filial responsibility lawLikely
Yes – rarely enforced (Cal. Fam. Code § 4400; Cal. Penal Code § 270c; relief for abandoned children Fam. Code §§ 4410-4411; Welf. & Inst. Code § 12350)
Where this comes from
an adult child shall, to the extent of the adult child's ability, support a parent who is in need

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. Penal Code 270c makes failure to support an indigent parent a misdemeanor. W&I 12350: 'No relative shall be held legally liable to support' applicants/recipients of aid under that chapter (SSP), and bars counties from demanding support - limits government use. Child abandoned by parent as a minor (2+ years) can petition for relief (Fam. Code 4411). 'Enforced: rare' is judgment - no reported recent nursing-home collection suits found (not exhaustively searched).

Care at home and other programs

Home and community waiversUnconfirmed
Where this comes from

No quote captured.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

DHCS pages could not be fetched. Search snippets of DHCS ALW policy letter 24-002 describe a DHCS-held master waitlist and 1,800 additional slots effective 3/1/2025; a 9/2025 advocate letter cites a ~13,000-person waitlist. HCBA/MSSP waitlist status not verified.

Assisted livingUnconfirmed
Medi-Cal does not pay room and board in assisted living (RCFEs); services can be covered via the Assisted Living Waiver in participating counties (waitlist) or CalAIM Community Supports from managed care plans.
Where this comes from

No quote captured.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Not fetched (bot wall); based on search snippets. ALW is not statewide.

PACELikelySecondary source
42 PACE organizations, 124 centers, 32,000+ enrollees across 28 of 58 counties (July 2026). DHCS paused new PACE organization and service-area-expansion applications for at least two years starting late 2025.
Where this comes from
California is home to 42 PACE organizations

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

CHCF (California Health Care Foundation) report 9/28/2026 citing DHCS data; DHCS PACE plan list could not be fetched.

Long-term-care Partnership insuranceVerified source
Yes - California Partnership for Long-Term Care (est. 1994), dollar-for-dollar protection from estate recovery. DHCS's certified-companies page reportedly states no participating insurers are currently selling Partnership policies.
Where this comes from
Each dollar a Partnership policy pays out in benefits allows a policyholder to protect one dollar of assets

Source page · Agency guidance · as of 2025 · retrieved 2026-11-04

CDI Attachment V (March 2025). 'No company currently selling' status is from a DHCS page search snippet (not fetched) - verify. California's original 1990s Partnership is a non-DRA program; reciprocity with other states not verified.

Medicare and Medigap

Birthday / anniversary switch ruleVerified source
Yes
Description
Annual open enrollment of at least 60 days starting on the policyholder's birthday; may buy a policy with equal or lesser benefits from any issuer without underwriting.
Where this comes from

Cal. Ins. Code § 10192.11(h)(1)

an annual open enrollment period lasting 60 days or more, commencing with the individual’s birthday

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. Window was 30 days before 2020.

Year-round Medigap enrollmentLikely
No
Where this comes from

Cal. Ins. Code § 10192.11

an annual open enrollment period lasting 60 days or more, commencing with the individual’s birthday

Source page · Official code · as of 2026 · retrieved 2026-11-04

No year-round guaranteed issue; windows are birthday-based (h)(1), event-based (e.g. 60 days after MA plan termination, subd. (g)), and the age-65/Part B six-month window. Absence of continuous enrollment inferred from the statute's structure.

Medigap for under-65 (disability)Verified source
Yes
Where this comes from

Cal. Ins. Code § 10192.11(d)

An individual enrolled in Medicare by reason of disability shall be entitled to open enrollment.

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. Six-month open enrollment from Part B enrollment; issuers must make all policies available. Premium differences for under-65 not researched.

Help paying Medicare premiums (QMB/SLMB/QI)Verified sourcearchived copy of official page, 2026-02-27
Asset limit individual
130,000
Asset limit couple
195,000
Asset test eliminated
No
Note
Asset test for QMB/SLMB/QI reinstated 1/1/2026 at the Medi-Cal $130,000/$65,000-per-additional-person level (none in 2024-2025); scheduled to drop with the general limit July 2027. Income limits follow federal FPL percentages (not separately verified).
Where this comes from

DHCS ACWDL 25-14; ACWDL 26-02

No sooner than January 1, 2026, the asset test shall be reinstated for Non-MAGI programs, including LTC and MSPs, except for the Pickle, DAC, and DW programs.

Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04

Limits: ACWDL 25-14 'the asset limits will be set at $130,000 for one person and $65,000 for each additional person (up to a maximum of 10 people)'; ACWDL 26-02 'The property limits are $130,000 for an individual, $195,000 for a couple'. DHCS ACWDL 25-27 ('2026 Medicare Savings Program Property Limits') has no Internet Archive snapshot.

OtherUnconfirmed
HICAP provides free Medicare counseling statewide.
Where this comes from

No quote captured.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Not fetched.

Ambulance bills and rides

Ground ambulance surprise billsVerified source
Yes
Scope
AB 716 (Stats. 2023), effective 1/1/2024: enrollees in state-regulated health plans/insurance pay only in-network cost-sharing to non-contracted ground ambulances; uninsured/self-pay patients capped at the greater of the Medi-Cal or Medicare rate. Does not apply to Medi-Cal managed care plans (Medi-Cal has its own no-billing rules) and, as state law, generally does not reach self-funded ERISA employer plans.
Where this comes from

Health & Safety Code § 1371.56 (plans); companion Insurance Code section; H&S Code § 1797.232 (uninsured cap)

no more than the same cost-sharing amount

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. § 1371.56 applies to contracts 'issued, amended, or renewed on or after January 1, 2024' and 'does not apply to a Medi-Cal managed health care service plan'. Uninsured cap per KVCR news 11/13/2023: 'caps bills for uninsured people to no more than the Medi-Cal or Medicare rate, whichever is greater.' (H&S 1797.232 text not fetched.) ERISA point is general law, not from a fetched page.

Air ambulanceNot found
Not confirmed
Where this comes from

No quote captured.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Not researched beyond federal No Surprises Act.

Medicaid non-emergency ridesLikelySecondary source
Medi-Cal managed care members request NEMT/NMT through their plan (member services); NEMT requires a Physician Certification Statement form from the provider and prior authorization; NMT (rides for members with no other transport) does not need a PCS. Fee-for-service NEMT via DHCS San Diego Field Office (916) 688-6131.
Where this comes from
You must have an approved Physician Certification Statement (PCS) form authorizing NEMT by your provider.

Source page · Secondary source · as of 2022 · retrieved 2026-11-04

Disability Rights California publication F120.01 (Dec 2022); DHCS transportation page could not be fetched.

OtherNot foundSecondary source
Not confirmed
Where this comes from

No quote captured.

Source page · Secondary source · as of 2026 · retrieved 2026-11-04

Medicare beneficiaries: ambulance suppliers must accept Medicare assignment; not separately verified here.

Other protections

Other protectionsLikely
Elder/dependent adult abuse (incl. financial abuse) mandated reporting: caregivers and many professionals are mandated reporters; abuse in a long-term care facility must be reported to law enforcement within 2 hours (serious injury) with written report within 24 hours; otherwise immediate phone report and written report within two working days.
Where this comes from

Welf. & Inst. Code § 15630

within two working days

Source page · Official code · as of 2026 · retrieved 2026-11-04

Statute text read via california.public.law (mirror of leginfo.legislature.ca.gov, which returned HTTP 403 to automated fetch); page marked verified 2026-11-02. Bed-hold and involuntary discharge rules not researched.

Federal rules that apply everywhere

These federal rules apply in every state and DC.

Federal gotchas

Observation status can wipe out SNF coverage

A parent can spend several nights in a hospital bed 'under observation' (outpatient) and never meet the 3-day INPATIENT requirement, so Medicare pays nothing for the rehab/nursing home stay that follows. Ask every day: 'Is she inpatient or observation?' Read the MOON notice (required after 24 hours of observation), ask the doctor to reconsider admission, check if a Medicare Advantage plan or ACO waives the 3-day rule, and if a stay was switched from inpatient to observation, appeal.

Verified source
Where this comes from

42 CFR 409.30(a)

This means a prior medically necessary inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, but not including the day you leave the hospital).

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: 'Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight.' ACO waivers and Medicare Advantage plans may waive the 3-day rule.

Medicare does not pay for long-term nursing home care

Medicare (and Medigap) covers only short-term skilled care (max 100 days per benefit period, $217/day from day 21 in 2026, and only while daily skilled care is needed). Custodial care in a nursing home, assisted living, or at home is private-pay, LTC insurance, VA, or Medicaid. Plan for Medicaid before the money runs out.

Verified source
Where this comes from
Since most long-term care is non-medical, Medicare and most health insurance, including Medicare Supplement Insurance (Medigap) , don’t pay for long-term care services, including care in a nursing home or in the community.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

SNF coverage often ends long before day 100

Coverage stops as soon as the facility decides daily skilled care is no longer needed ('plateaued'); there is no right to 100 days. Request a fast appeal from the notice of non-coverage, and remember 'improvement' isn't required: maintenance therapy can qualify.

Verified source
Where this comes from
Days 21–100: You pay $217 each day. Days 101 and beyond: You pay all costs. Part A limits SNF coverage to 100 days in each benefit period.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Days 1-20: 'You pay $0 each day after you pay the $1,736 deductible' (deductible not owed again if already paid for the hospital stay in the same benefit period). CMS fact sheet: '$217.00 in 2026 ($209.50 in 2025)'. The 100 days are a maximum, not a guarantee: coverage ends when daily skilled care is no longer needed.

Gifts within 5 years delay Medicaid, and the penalty clock starts late

Any gift (cash to grandkids, deeding the house) within 60 months of applying triggers a penalty. The penalty doesn't start when the gift is made; it starts only once the parent has spent down, applied, and would otherwise be eligible, which leaves a stretch with no money and no Medicaid. Partial months can't be rounded away.

Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(D)(ii)

the date specified in this subparagraph is the first day of a month during or after which assets have been transferred for less than fair market value, or the date on which the individual is eligible for medical assistance under the State plan and would otherwise be receiving institutional level care described in subparagraph (C) based on an approved application for such care but for the application of the penalty period, whichever is later

Source page · Official code · as of current statute · retrieved 2026-11-04

Gifting the house can cost the kids capital-gains tax

A gifted house keeps the parent's old (low) basis; an inherited house gets a stepped-up basis at death. Gifting a house to dodge Medicaid can create a large taxable gain when the child sells, plus a look-back penalty. Consider exempt transfers (caregiver child, disabled child, spouse) or other planning with an elder-law attorney.

Verified source
Where this comes from

IRC 1015 (gifts), 1014 (inherited); IRS Pub. 551

If the FMV of the property is equal to or greater than the donor's adjusted basis, your basis is the donor's adjusted basis at the time you received the gift.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Inherited: 'Generally, the basis of property inherited from a decedent is one of the following. The FMV of the property at the date of the individual's death.' Why it matters: a house bought for $80k and gifted to a child while worth $400k carries the $80k basis; if the child sells, ~$320k gain is taxable (and the child usually can't use the parent's IRC 121 exclusion). If inherited instead, basis steps up to ~$400k and little or no gain results. Gifting also starts a 60-month Medicaid look-back penalty.

Joint bank accounts are treated as the parent's money

Under SSI rules (which most state Medicaid programs follow), all funds in a joint account are presumed to belong to the applicant unless rebutted with evidence. Adding a child's name doesn't protect money, and removing money from a joint account can count as a gift.

Likely
Where this comes from

SSA POMS SI 01140.205

Account holders include one or more claimants or recipients If there is more than one claimant or recipient, assume that all the funds in the account belong to the claimant(s) or recipient(s), in equal shares.

Source page · Agency guidance · as of 2023-12-27 · retrieved 2026-11-04

SSI rule; Medicaid aged/blind/disabled eligibility generally follows SSI methodology (42 CFR 435.601), but states can differ: check state files.

A power of attorney without explicit gifting power can block Medicaid planning

Under Uniform Power of Attorney Act states, an agent can make gifts, change beneficiaries, or create/change survivorship rights ONLY if the POA expressly says so. If the parent has lost capacity, the family may need a costly guardianship to do planning. Review the POA now while the parent can sign a new one.

Likely
Where this comes from

N.C. Gen. Stat. 32C-2-201 (example of UPOAA sec. 201)

An agent may do the following on behalf of the principal or with the principal's property only if the power of attorney expressly grants the agent that authority: a. Make a gift. b. Create or change rights of survivorship. c. Create or change a beneficiary designation.

Source page · Official code · as of current statute · retrieved 2026-11-04

State law, not federal; shown as a representative UPOAA enactment. Check each state's POA statute.

Don't sign the nursing home admission agreement as a guarantor

Federal rules bar Medicare/Medicaid nursing facilities from requiring a third-party guarantee of payment. Facilities still use 'Responsible Party' language. Sign only as the resident's representative/agent (using the resident's funds), cross out personal guarantees, and never agree to pay personally.

Verified source
Where this comes from

42 CFR 483.15(a)(3)

The facility must not request or require a third party guarantee of payment to the facility as a condition of admission or expedited admission, or continued stay in the facility. However, the facility may request and require a resident representative who has legal access to a resident's income or resources available to pay for facility care to sign a contract, without incurring personal financial liability, to provide facility payment from the resident's income or resources.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Arbitration clauses are optional, and you can rescind within 30 days

Nursing homes may not require binding arbitration as a condition of admission or continued care, and the agreement must allow rescission within 30 calendar days. Decline or rescind to keep the right to sue over neglect or abuse.

Verified source
Where this comes from

42 CFR 483.70(m)

The facility must not require any resident or his or her representative to sign an agreement for binding arbitration as a condition of admission to, or as a requirement to continue to receive care at, the facility

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Same section: 'The agreement must explicitly grant the resident or his or her representative the right to rescind the agreement within 30 calendar days of signing it.'

IRMAA surprise two years after selling the house or cashing out an IRA

Medicare premiums are based on income from 2 years earlier. A home sale gain above the $250k/$500k exclusion, a big IRA withdrawal, or a Roth conversion can raise Part B to as much as $689.90/month plus a Part D surcharge two years later. A one-time sale is NOT a life-changing event for an SSA-44 appeal (but a spouse's death, retirement, or lost pension is). Spread income across years when possible.

Verified source
Where this comes from

20 CFR 418.1205; SSA POMS HI 01120.001

You or your spouse experiences a loss of income-producing property, provided the loss is not at the direction of you or your spouse (e.g., due to the sale or transfer of the property) and is not a result of the ordinary risk of investment.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Selling a house or other property is NOT a life-changing event. POMS HI 01120.001: 'the SSA-44 , Medicare Income-Related Monthly Adjustment Amount Life Changing Event is available online' and 'The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on a valid LCE'.

Switching from Medicare Advantage back to Original Medicare can leave you without a Medigap

Federal Medigap guaranteed issue lasts only 6 months from Part B at 65, plus narrow situations. After the 12-month MA 'trial right' passes, a parent with health problems who leaves Medicare Advantage (e.g., to use an out-of-network specialist or nursing home) can be denied Medigap in most states. Choose carefully at 65.

Verified source
Where this comes from
There’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet their medical underwriting requirements. They may deny you a policy unless you have a guaranteed issue right

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Medicare.gov 'Choosing a Medigap Policy' guide (2026 edition).

Ground ambulance bills aren't covered by the No Surprises Act

The federal No Surprises Act protects against surprise air-ambulance and ER bills, but generally not ground ambulance. Out-of-network ground ambulances can balance-bill privately insured patients unless state law protects them. With Original Medicare, the patient owes 20% coinsurance after the deductible.

Verified source
Where this comes from
Generally, ground ambulance services aren't covered by billing protections in the No Surprises Act (unless a state law has different rules). They're still allowed to charge out-of-network rates.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: the NSA protects against surprise out-of-network bills from 'emergency room visits; non-emergency care related to visits at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers; and air ambulance services.' NSA applies to private/commercial coverage; Medicare and Medicaid already limit balance billing by participating ambulance suppliers.

Scheduled non-emergency ambulance trips can be billed to you if prior authorization is denied

For repeated scheduled trips (e.g., dialysis), Medicare requires prior authorization by the 4th round trip in 30 days; if denied and the trips continue, the company may bill the full charge. Non-emergency trips also need a physician certification and an ABN when Medicare may not pay.

Verified source
Where this comes from
If your prior authorization request isn't approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: 'You get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more You get this transportation from any ambulance company nationwide'.

Retroactive Medicaid shrinks from 3 months to 2 starting with 2027 applications

For applications made on or after Jan. 1, 2027, Medicaid for older/disabled applicants can reach back only to the 2nd month before the application month (1 month for expansion adults). Nursing home bills from earlier months may not be covered, so apply as soon as the parent might qualify.

Verified source
Where this comes from

Pub. L. 119-21 sec. 71112, amending 42 U.S.C. 1396a(a)(34) and 1396d(a)

is not described in subparagraph (A), such assistance will be made available to the individual for care and services included under the plan and furnished in or after the second month before the month in which the individual made application

Source page · Official code · as of 2027 · retrieved 2026-11-04

Applies to eligibility 'based on an application made on or after the first day of the first quarter that begins after December 31, 2026' (i.e., Jan. 1, 2027). Older adults needing nursing-home Medicaid fall in the 'not described in subparagraph (A)' (2-month) group. The replaced statutory text was 'in or after the third month before the month in which the recipient makes application'.

Home equity cap drops to a flat $1,000,000 in 2028

Nursing-home Medicaid is denied if home equity exceeds the state's limit (2026: $752,000 to $1,130,000) unless a spouse or minor/disabled child lives there. From Jan. 1, 2028, the cap for non-agricultural homes can't exceed $1,000,000 and won't rise with inflation. A reverse mortgage or home equity loan can reduce equity.

Verified source
Where this comes from

Pub. L. 119-21 (One Big Beautiful Bill Act) sec. 71108, amending 42 U.S.C. 1396p(f)

A State may elect, without regard to the requirements of section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability), to apply subparagraph (A), in the case of an individual's home that is not described in clause (i), by substituting for the amount specified in such subparagraph, an amount that exceeds such amount, but does not exceed $1,000,000.

Source page · Official code · as of 2028 · retrieved 2026-11-04

Effective-date text: 'The amendments made by subsection (a) shall apply beginning on January 1, 2028.' Also adds: inflation-indexed amounts (other than for agricultural-lot homes) exceeding $1,000,000 'shall be deemed to be equal to $1,000,000'. States currently above $1M (2026 max is $1,130,000) will have to drop to $1M for non-agricultural homes.

Estate recovery can reach the house and more

States must recover nursing home and home-care costs from the estates of people who got Medicaid at 55+. Many states expand 'estate' beyond probate to joint property, life estates, and living trusts. Recovery waits until a surviving spouse dies and doesn't apply while a child under 21 or a blind/disabled child survives; ask about hardship waivers.

Verified source
Where this comes from

42 U.S.C. 1396p(b)(4)(B)

may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (1)(C)(i) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.

Source page · Official code · as of current statute · retrieved 2026-11-04

Partnership LTC policyholders (1396p(b)(1)(C)(i)) are subject to the expanded definition for non-protected assets.

Annuities and promissory notes must meet strict rules or they count as gifts

A Medicaid-compliant annuity must name the state as remainder beneficiary and be irrevocable, nonassignable, actuarially sound, and pay equal installments. Family loans/promissory notes must be actuarially sound, pay equal installments, and can't be forgiven at death, or the money counts as a transfer.

Verified source
Where this comes from

42 U.S.C. 1396p(c)(1)(I)

the term "assets" includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— (i) has a repayment term that is actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); (ii) provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and (iii) prohibits the cancellation of the balance upon the death of the lender.

Source page · Official code · as of current statute · retrieved 2026-11-04

Caregiver-child home transfer requires 2 years of live-in care

A parent can deed the home to a child without penalty only if the child lived there for at least 2 years immediately before the parent's institutionalization and provided care that kept the parent out of a facility, as the state determines. Document the care (doctor letters, care logs) now.

Verified source
Where this comes from

42 U.S.C. 1396p(c)(2)(A)-(D)

(iv) a son or daughter of such individual (other than a child described in clause (ii)) who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual, and who (as determined by the State) provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility

Source page · Official code · as of current statute · retrieved 2026-11-04

Quote shows the caregiver-child exemption; the other listed exemptions are in the same subsection (c)(2)(A)(i)-(iii), (B)(i)-(iv), (C)(i)-(iii), (D).

Hospice doesn't pay nursing home room and board

Choosing hospice in a nursing home or at home doesn't cover room and board. The family or Medicaid still pays the facility's daily rate.

Verified source
Where this comes from
Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: 'Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).'

Income just over the cap needs a Miller trust (QIT)

In income-cap states, a parent with income even $1 over $2,982/month (2026) is ineligible for nursing-home Medicaid unless the excess goes into a Qualified Income (Miller) Trust each month. Missing a month's deposit can cause ineligibility for that month.

Verified source
Where this comes from

42 U.S.C. 1396p(d)(4)(B)

A trust established in a State for the benefit of an individual if— (i) the trust is composed only of pension, Social Security, and other income to the individual (and accumulated income in the trust), (ii) the State will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State plan under this subchapter; and (iii) the State makes medical assistance available to individuals described in section 1396a(a)(10)(A)(ii)(V) of this title, but does not make such assistance available to individuals for nursing facility services under section 1396a(a)(10)(C) of this title.

Source page · Official code · as of current statute · retrieved 2026-11-04

Medicare (all states)

Part a › inpatient deductibleVerified source
$1,736 per benefit period
Where this comes from
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,736 in 2026, an increase of $60 from $1,676 in 2025.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Part a › hospital coinsuranceVerified source
Days61to90
$434/day
Lifetime reserve per day
$868/day
Where this comes from
In 2026, beneficiaries must pay a coinsurance amount of $434 per day for the 61 st through 90 th day of a hospitalization ($419 in 2025) in a benefit period and $868 per day for lifetime reserve days ($838 in 2025).

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Part a › premiumVerified source
Premium free if40 quarters
$0/month
Reduced30to39 quarters
$311/month
Full
$565/month
Where this comes from
may buy into Part A at a reduced monthly premium rate, which will be $311 in 2026, a $26 increase from 2025. Certain uninsured aged individuals who have fewer than 30 quarters of coverage, and certain individuals with disabilities who have exhausted other entitlements, will pay the full premium, which will be $565 a month in 2026

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Snf › three day inpatient ruleVerified source
Requires a medically necessary INPATIENT stay of at least 3 consecutive days (admission day counts, discharge day does not); observation and ER time do not count; generally must enter SNF within 30 days.
Where this comes from

42 CFR 409.30(a)

This means a prior medically necessary inpatient hospital stay of at least 3 days in a row (starting the day you were admitted as an inpatient, but not including the day you leave the hospital).

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: 'Time you spend at the hospital under observation or in the emergency room before you're admitted doesn't count toward the 3-day qualifying inpatient hospital stay, even if you're there overnight.' ACO waivers and Medicare Advantage plans may waive the 3-day rule.

Snf › regulationVerified source
3 consecutive calendar days not counting discharge date; admission within 30 days of discharge.
Where this comes from

42 CFR 409.30(a)(1)

Have been hospitalized in a participating or qualified hospital or participating CAH, for medically necessary inpatient hospital or inpatient CAH care, for at least 3 consecutive calendar days, not counting the date of discharge

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Snf › cost sharingVerified source
Days1to20
$0/day
Days21to100 per day
$217/day
After100
beneficiary pays all costs
Where this comes from
Days 21–100: You pay $217 each day. Days 101 and beyond: You pay all costs. Part A limits SNF coverage to 100 days in each benefit period.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Days 1-20: 'You pay $0 each day after you pay the $1,736 deductible' (deductible not owed again if already paid for the hospital stay in the same benefit period). CMS fact sheet: '$217.00 in 2026 ($209.50 in 2025)'. The 100 days are a maximum, not a guarantee: coverage ends when daily skilled care is no longer needed.

Snf › observation status moonVerified source
Hospitals must give the Medicare Outpatient Observation Notice (MOON) to anyone in observation more than 24 hours, no later than 36 hours after observation starts.
Where this comes from

42 CFR 489.20(y) (NOTICE Act)

to provide notice, as specified in paragraphs (y)(1) and (2) of this section, to each individual entitled to Medicare benefits under Title XVIII of the Act when such individual receives observation services as an outpatient for more than 24 hours. Notice must be provided to the individual not later than 36 hours after observation services are initiated or sooner if the individual is transferred, discharged, or admitted.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Snf › observation appealVerified source
Patients admitted as inpatients and later switched to outpatient observation may appeal; appeals available back to January 2009.
Where this comes from
If you’re a Medicare patient who was admitted to the hospital as an inpatient, and the hospital changed your status to “outpatient getting observation services,” you may be able to appeal the denial of Part A (Hospital Insurance) inpatient coverage that came from the change in your status.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Page heading: 'You can appeal past hospital stays back to January 2009'. Appeal right applies to inpatient-then-reclassified stays, not to people who were in observation from the start.

Part b › premiumVerified source
$202.90/month
Where this comes from
The standard monthly premium for Medicare Part B enrollees will be $202.90 for 2026, an increase of $17.90 from $185.00 in 2025.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Part b › deductibleVerified source
$283/year
Where this comes from
The annual deductible for all Medicare Part B beneficiaries will be $283 in 2026, an increase of $26 from the annual deductible of $257 in 2025.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Part b › premium2027Not found
Not confirmed
Where this comes from

No quote captured.

Source page · Agency guidance · as of 2027 · retrieved 2026-11-04

CMS had not published 2027 Part A/B premiums and deductibles as of 2026-11-04 (expected fact-sheet URL returned 404). Only Trustees Report projections exist; not recorded.

Irmaa › brackets2026Verified source
Part b
  • Single
    <=109000
    Joint
    <=218000
    Total premium
    $202.90/month
    Part dadd
    $0/month
  • Single
    109001-137000
    Joint
    218001-274000
    Total premium
    $284.10/month
    Part dadd
    $14.50/month
  • Single
    137001-171000
    Joint
    274001-342000
    Total premium
    $405.80/month
    Part dadd
    $37.50/month
  • Single
    171001-205000
    Joint
    342001-410000
    Total premium
    $527.50/month
    Part dadd
    $60.40/month
  • Single
    205001-499999
    Joint
    410001-749999
    Total premium
    $649.20/month
    Part dadd
    $83.30/month
  • Single
    >=500000
    Joint
    >=750000
    Total premium
    $689.90/month
    Part dadd
    $91/month
Married filing separately
  • Magi
    <=109000
    Total premium
    $202.90/month
    Part dadd
    $0/month
  • Magi
    109001-390999
    Total premium
    $649.20/month
    Part dadd
    $83.30/month
  • Magi
    >=391000
    Total premium
    $689.90/month
    Part dadd
    $91/month
Where this comes from
Less than or equal to $109,000 Less than or equal to $218,000 $0.00 $202.90 Greater than $109,000 and less than or equal to $137,000 Greater than $218,000 and less than or equal to $274,000 $81.20 $284.10

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Total monthly Part B premium per person; partDAdd is the Part D income-related adjustment added to the plan premium. Full table on the CMS fact sheet; also in SSA POMS HI 01101.020.

Irmaa › two year look backVerified source
IRMAA for year X uses MAGI from the tax return for year X-2 (2026 premiums use 2024 MAGI).
Where this comes from

20 CFR 418.1135(a)

In general, we will use your modified adjusted gross income provided by IRS for the tax year 2 years prior to the effective year of the income-related monthly adjustment amount determination.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

SSA POMS HI 01101.020 (2026 tables): 'If MAGI in 2024 (or 2023 if 2024 is not available) was:'. MAGI = AGI plus tax-exempt interest (20 CFR 418.1010), so capital gains from selling a home (above the IRC 121 exclusion), IRA withdrawals, and Roth conversions all count.

Irmaa › life changing event appealVerified source
Form
SSA-44
Qualifying events
  • death of spouse
  • marriage
  • divorce/annulment
  • work stoppage
  • work reduction
  • loss of income-producing property (not by sale)
  • loss of employer pension
  • employer settlement payment
Where this comes from

20 CFR 418.1205; SSA POMS HI 01120.001

You or your spouse experiences a loss of income-producing property, provided the loss is not at the direction of you or your spouse (e.g., due to the sale or transfer of the property) and is not a result of the ordinary risk of investment.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

Selling a house or other property is NOT a life-changing event. POMS HI 01120.001: 'the SSA-44 , Medicare Income-Related Monthly Adjustment Amount Life Changing Event is available online' and 'The SSA-44 is only for beneficiaries wishing to request a new initial determination, based on a valid LCE'.

Part d › out of pocket capVerified source
2026
$2,100/year
2027
$2,400/year
Where this comes from

CMS CY 2027 Rate Announcement (Apr. 6, 2026), Attachment V, Table V-2

Table V-2. Updated Part D Benefit Parameters for Defined Standard Benefit, Low-Income Subsidy (LIS) and Retiree Drug Subsidy 2026 202713 Standard Benefit Deductible $615 $700 Out-of-Pocket Threshold $2,100 $2,400

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

'202713' in the quote is '2027' followed by footnote marker 13. Standard deductible: $615 (2026), $700 (2027).

Medigap › federal open enrollmentVerified source
One-time 6-month window starting the first month a person is both 65+ and enrolled in Part B; insurer cannot deny or price on health.
Where this comes from

42 U.S.C. 1395ss(s)(2)(A)

The issuer of a medicare supplemental policy may not deny or condition the issuance or effectiveness of a medicare supplemental policy, or discriminate in the pricing of the policy, because of health status, claims experience, receipt of health care, or medical condition in the case of an individual for whom an application is submitted prior to or during the 6 month period beginning with the first month as of the first day on which the individual is 65 years of age or older and is enrolled for benefits under part B.

Source page · Official code · as of current statute · retrieved 2026-11-04

Medicare.gov guide: 'This is a one-time enrollment period; it doesn’t repeat every year.' Federal law gives no Medigap open enrollment to under-65 disabled beneficiaries; some states do.

Medigap › guaranteed issue rightsVerified source
  • Employer/union retiree plan supplementing Medicare ends
  • Medicare Advantage plan leaves the area/terminates or person moves out of service area (or PACE)
  • Medigap insurer goes bankrupt/coverage ends involuntarily, or insurer violated policy or misled the person
  • Trial right: dropped Medigap to join Medicare Advantage for the first time and leaves within 12 months
  • Trial right: joined Medicare Advantage/PACE when first eligible at 65 and leaves within 12 months
Where this comes from

42 U.S.C. 1395ss(s)(3)(B)(i)-(vi)

The individual, upon first becoming eligible for benefits under part A at age 65, en rolls in a Medicare+Choice plan under part C or in a PACE program under section 1395eee of this title, and disenrolls from such plan or such program by not later than 12 months after the effective date of such enrollment.

Source page · Official code · as of current statute · retrieved 2026-11-04

Quote reproduces an 'en rolls' word-break artifact in the govinfo HTML. Guaranteed-issue applicants are limited to certain plans (statute lists A, B, C, F; Medicare.gov guide lists current equivalents including G for those new to Medicare after 2020). States may add rights.

Medigap › no federal right to switchVerified source
Outside open enrollment and guaranteed-issue situations, insurers may medically underwrite or deny Medigap.
Where this comes from
In most cases, you won’t have a right under federal law to switch Medigap policies, unless: You're within your 6-month Medigap open enrollment period, or You're eligible under a specific situation or guaranteed issue right (when an insurance company can’t deny you a Medigap policy).

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Medigap › ma to medigap trapVerified source
Leaving Medicare Advantage after the 12-month trial right generally means Medigap insurers can underwrite/deny (except in states with extra protections).
Where this comes from
There’s no guarantee that an insurance company will sell you a Medigap policy if you don’t meet their medical underwriting requirements. They may deny you a policy unless you have a guaranteed issue right

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Medicare.gov 'Choosing a Medigap Policy' guide (2026 edition).

Custodial careVerified source
Medicare (and Medigap) do not pay for long-term custodial care, including in a nursing home.
Where this comes from
Since most long-term care is non-medical, Medicare and most health insurance, including Medicare Supplement Insurance (Medigap) , don’t pay for long-term care services, including care in a nursing home or in the community.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

HospiceVerified source
Covered under Part A with certification of terminal illness (6 months or less); patient elects comfort care; up to $5 drug copay and 5% respite; room and board NOT covered.
Where this comes from
Room and board. Medicare doesn't cover room and board if you get hospice care in your home or if you live in a nursing home or a hospice inpatient facility.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: 'Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy of 6 months or less).'

Home healthVerified source
Must be homebound and need part-time/intermittent skilled care; no 24-hour care, no homemaker, no custodial-only care; usually up to 28 hrs/week combined.
Where this comes from
Custodial or personal care that helps you with daily living activities (like bathing, dressing, or using the bathroom), when this is the only care you need

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Listed under 'Medicare doesn't pay for:' along with '24-hour-a-day care at your home'. Same page: 'up to 8 hours a day (combined), for a maximum of 28 hours a week.'

Federal Medicaid rules (all states)

Ssi federal benefit rate › individualVerified source
$994/month
Where this comes from

CMCS Informational Bulletin, Apr. 27, 2026 (2026 SSI and Spousal Impoverishment Standards chart, effective 1-1-26)

Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Table columns: SSI FBR, SSI resource standard, income cap limit (300%), earned and unearned income break-even points. Whitespace normalized from PDF table.

Ssi federal benefit rate › coupleVerified source
$1,491/month
Where this comes from

CMCS Informational Bulletin, Apr. 27, 2026

Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Ssi federal benefit rate › individual2027Verified source
$1,029/month
Where this comes from

SSA Notice, Cost-of-Living Increase and Other Determinations for 2027, Docket No. SSA-2026-1024 (FR Doc. 2026-21796)

The maximum Federal Supplemental Security Income (SSI) monthly payment amounts for 2027 under title XVI of the Act will be $1,029 for an eligible individual; $1,544 for an eligible individual with an eligible spouse; and $516 for an essential person.

Source page · Official regulation · as of 2027 · retrieved 2026-11-04

Federal Register public-inspection copy. 3.6% COLA. CMS has not yet (as of 2026-11-04) published its 2027 SSI and Spousal Impoverishment Standards chart.

Ssi federal benefit rate › couple2027Verified source
$1,544/month
Where this comes from

SSA Notice, Docket No. SSA-2026-1024

The maximum Federal Supplemental Security Income (SSI) monthly payment amounts for 2027 under title XVI of the Act will be $1,029 for an eligible individual; $1,544 for an eligible individual with an eligible spouse; and $516 for an essential person.

Source page · Official regulation · as of 2027 · retrieved 2026-11-04

Ssi resource standardVerified source
Individual
$2,000
Couple
$3,000
Where this comes from
Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Most states use $2,000 as the nursing-home Medicaid asset limit for a single applicant, but states vary; see state files.

Special income limit300 pctVerified source
$2,982/month
Where this comes from

SSA 1902(a)(10)(A)(ii)(V); CMCS chart 'Income Cap Limit (300%)'

Individual 994.00 2,000.00 2,982.00 2,073.00 1,014.00 Couple 1,491.00 3,000.00 N/A 3,067.00 1,511.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

In income-cap states, income above this requires a Miller trust / QIT.

Special income limit300 pct2027Likely
$3,087/month
Where this comes from
The maximum Federal Supplemental Security Income (SSI) monthly payment amounts for 2027 under title XVI of the Act will be $1,029 for an eligible individual

Source page · Official regulation · as of 2027 · retrieved 2026-11-04

DERIVED: 3 x $1,029 = $3,087. Not yet published by CMS; confirm against the CMS 2027 SSI and Spousal Impoverishment Standards chart (normally issued in December).

Personal needs allowance federal minimumVerified source
Individual
$30/month
Couple
$60/month
Where this comes from

42 U.S.C. 1396a(q)(2)

is $30 for an institutionalized individual and $60 for an institutionalized couple (if both are aged, blind, or disabled, and their incomes are considered available to each other in determining eligibility)

Source page · Official code · as of current statute · retrieved 2026-11-04

Federal floor only; nearly all states set higher amounts (see state files).

Spousal impoverishment › csra minVerified source
$32,532
Where this comes from

42 U.S.C. 1396r-5(f)(2), (g); CMCS 2026 chart

Community Spouse Resources: Minimum Resource Standard: 32,532.00 Maximum Resource Standard 162,660.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Spousal impoverishment › csra maxVerified source
$162,660
Where this comes from

42 U.S.C. 1396r-5(g); CMCS 2026 chart

Community Spouse Resources: Minimum Resource Standard: 32,532.00 Maximum Resource Standard 162,660.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Spousal impoverishment › mmmna minVerified source
From2026-07-01
Contiguous states
$2,705/month
Alaska
$3,381.25/month
Hawaii
$3,111.25/month
2026-01-01to2026-06-30
Contiguous states
$2,643.75/month
Alaska
$3,303.75/month
Hawaii
$3,040/month
Where this comes from
Minimum Monthly Maintenance Needs Allowance 2,705.00 All States (Except Alaska and Hawaii) (Effective 7-1-26) 3,381.25 Alaska 3,111.25 Hawaii

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

MMMNA minimum changes each July 1 with the poverty guidelines. The Dec. 9, 2025 chart (cib12092025.pdf) lists 2,643.75 / 3,303.75 / 3,040.00 '(Effective 7-1-25)' for January-June 2026.

Spousal impoverishment › mmmna maxVerified source
$4,066.50/month
Where this comes from
Maximum Monthly Maintenance Needs Allowance: 4,066.50

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Spousal impoverishment › community spouse housing allowanceVerified source
From2026-07-01
Contiguous states
$811.50/month
Alaska
$1,014.38/month
Hawaii
$933.38/month
2026-01-01to2026-06-30
Contiguous states
$793.13/month
Alaska
$991.13/month
Hawaii
$912/month
Where this comes from
Community Spouse Monthly Housing Allowance: 811.50 All States (Except Alaska and Hawaii) (Effective 7-1-26) 1,014.38 Alaska 933.38 Hawaii

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Basis for the excess shelter allowance.

Spousal impoverishment › snapshot dateVerified source
Resources of BOTH spouses are totaled as of the beginning of the first continuous period of institutionalization; the community spouse's share is computed from that snapshot.
Where this comes from

42 U.S.C. 1396r-5(c)(1)(A)

There shall be computed (as of the beginning of the first continuous period of institutionalization (beginning on or after September 30, 1989) of the institutionalized spouse)— (i) the total value of the resources to the extent either the institutionalized spouse or the community spouse has an ownership interest, and (ii) a spousal share which is equal to ½ of such total value.

Source page · Official code · as of current statute · retrieved 2026-11-04

Spousal impoverishment › community spouse incomeVerified source
Community spouse's own income is not deemed available to the institutionalized spouse (name-on-the-check rule).
Where this comes from

42 U.S.C. 1396r-5(b)(1)

During any month in which an institutionalized spouse is in the institution, except as provided in paragraph (2), no income of the community spouse shall be deemed available to the institutionalized spouse.

Source page · Official code · as of current statute · retrieved 2026-11-04

Home equity › minVerified source
$752,000
Where this comes from

42 U.S.C. 1396p(f); CMCS 2026 chart

Home Equity Limits: Minimum: 752,000.00 Maximum: 1,130,000.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Home equity › maxVerified source
$1,130,000
Where this comes from

42 U.S.C. 1396p(f); CMCS 2026 chart

Home Equity Limits: Minimum: 752,000.00 Maximum: 1,130,000.00

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Home equity › exceptionsVerified source
Home equity limit does not apply if a spouse, or a child under 21 or blind/disabled, lawfully resides in the home.
Where this comes from

42 U.S.C. 1396p(f)(2)

Paragraph (1) shall not apply with respect to an individual if— (A) the spouse of such individual, or (B) such individual's child who is under age 21, or (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or permanently and totally disabled, or (with respect to States which are not eligible to participate in such program) is blind or disabled as defined in section 1382c of this title, is lawfully residing in the individual's home.

Source page · Official code · as of current statute · retrieved 2026-11-04

Home equity › change2028Verified source
Effective
2028-01-01
Non agricultural home cap
1,000,000
Indexed
No
Agricultural lot homes
keep the existing indexed state-option range
Where this comes from

Pub. L. 119-21 (One Big Beautiful Bill Act) sec. 71108, amending 42 U.S.C. 1396p(f)

A State may elect, without regard to the requirements of section 1902(a)(1) (relating to statewideness) and section 1902(a)(10)(B) (relating to comparability), to apply subparagraph (A), in the case of an individual's home that is not described in clause (i), by substituting for the amount specified in such subparagraph, an amount that exceeds such amount, but does not exceed $1,000,000.

Source page · Official code · as of 2028 · retrieved 2026-11-04

Effective-date text: 'The amendments made by subsection (a) shall apply beginning on January 1, 2028.' Also adds: inflation-indexed amounts (other than for agricultural-lot homes) exceeding $1,000,000 'shall be deemed to be equal to $1,000,000'. States currently above $1M (2026 max is $1,130,000) will have to drop to $1M for non-agricultural homes.

Retroactive coverageVerified source
Before2027
3 months before application month
For applications on or after2027-01-01
Expansion adults
1 month before application month
Aged_blind_disabled_and_other_non_expansion
2 months before application month
Where this comes from

Pub. L. 119-21 sec. 71112, amending 42 U.S.C. 1396a(a)(34) and 1396d(a)

is not described in subparagraph (A), such assistance will be made available to the individual for care and services included under the plan and furnished in or after the second month before the month in which the individual made application

Source page · Official code · as of 2027 · retrieved 2026-11-04

Applies to eligibility 'based on an application made on or after the first day of the first quarter that begins after December 31, 2026' (i.e., Jan. 1, 2027). Older adults needing nursing-home Medicaid fall in the 'not described in subparagraph (A)' (2-month) group. The replaced statutory text was 'in or after the third month before the month in which the recipient makes application'.

Look back › period monthsVerified source
60 months
Where this comes from

42 U.S.C. 1396p(c)(1)(B)(i)

The look-back date specified in this subparagraph is a date that is 36 months (or, in the case of payments from a trust or portions of a trust that are treated as assets disposed of by the individual pursuant to paragraph (3)(A)(iii) or (3)(B)(ii) of subsection (d) or in the case of any other disposal of assets made on or after February 8, 2006, 60 months) before the date specified in clause (ii).

Source page · Official code · as of current statute · retrieved 2026-11-04

California has historically used a different (shorter) look-back for Medi-Cal; see state files.

Look back › penalty startVerified source
Penalty starts on the later of (a) the first day of the month of the transfer, or (b) the date the applicant is otherwise eligible for Medicaid and would be receiving institutional-level care based on an approved application but for the penalty. In practice the clock does not start until the person has spent down and applied.
Where this comes from

42 U.S.C. 1396p(c)(1)(D)(ii)

the date specified in this subparagraph is the first day of a month during or after which assets have been transferred for less than fair market value, or the date on which the individual is eligible for medical assistance under the State plan and would otherwise be receiving institutional level care described in subparagraph (C) based on an approved application for such care but for the application of the penalty period, whichever is later

Source page · Official code · as of current statute · retrieved 2026-11-04

Look back › no rounding downVerified source
States may not round down or disregard partial months of penalty.
Where this comes from

42 U.S.C. 1396p(c)(1)(E)(iv)

A State shall not round down, or otherwise disregard any fractional period of ineligibility determined under clause (i) or (ii) with respect to the disposal of assets.

Source page · Official code · as of current statute · retrieved 2026-11-04

Look back › penalty divisorNot found
Not confirmed
Where this comes from

No quote captured.

Source page · Official code · as of 2026 · retrieved 2026-11-04

Divisor (average monthly private-pay nursing home cost) is set by each state; there is no federal figure. See state files.

Look back › exempt transfersVerified source
  • Home to spouse
  • Home to child under 21 or blind/disabled child
  • Home to sibling with equity interest who lived in the home at least 1 year before institutionalization
  • Home to 'caregiver child' who lived in the home at least 2 years before institutionalization and provided care that kept the parent out of a facility
  • Any asset to spouse or to another for the sole benefit of spouse
  • Any asset to (or trust solely for) a blind/disabled child
  • Any asset to a trust solely for a disabled person under 65
  • Showing that the transfer was intended for fair market value, or exclusively for a non-Medicaid purpose, or that assets were returned
  • Undue hardship waiver
Where this comes from

42 U.S.C. 1396p(c)(2)(A)-(D)

(iv) a son or daughter of such individual (other than a child described in clause (ii)) who was residing in such individual's home for a period of at least two years immediately before the date the individual becomes an institutionalized individual, and who (as determined by the State) provided care to such individual which permitted such individual to reside at home rather than in such an institution or facility

Source page · Official code · as of current statute · retrieved 2026-11-04

Quote shows the caregiver-child exemption; the other listed exemptions are in the same subsection (c)(2)(A)(i)-(iii), (B)(i)-(iv), (C)(i)-(iii), (D).

AnnuitiesVerified source
State remainder beneficiary
State must be named remainder beneficiary in first position (or second after community spouse/minor or disabled child) for at least the Medicaid paid
Safe harbor
irrevocable, nonassignable, actuarially sound per SSA Chief Actuary tables, equal payments with no deferral and no balloon (or qualifying IRA/retirement annuity)
Where this comes from

42 U.S.C. 1396p(c)(1)(F)-(G) (DRA 2005)

the purchase of an annuity shall be treated as the disposal of an asset for less than fair market value unless— (i) the State is named as the remainder beneficiary in the first position for at least the total amount of medical assistance paid on behalf of the institutionalized individual under this subchapter

Source page · Official code · as of current statute · retrieved 2026-11-04

Related text in (G)(ii): 'the annuity— (I) is irrevocable and nonassignable; (II) is actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); and (III) provides for payments in equal amounts during the term of the annuity, with no deferral and no balloon payments made.'

Promissory notesVerified source
Funds used to buy a promissory note, loan, or mortgage are a transfer unless the note is actuarially sound, pays in equal installments with no deferral/balloon, and prohibits cancellation at the lender's death.
Where this comes from

42 U.S.C. 1396p(c)(1)(I)

the term "assets" includes funds used to purchase a promissory note, loan, or mortgage unless such note, loan, or mortgage— (i) has a repayment term that is actuarially sound (as determined in accordance with actuarial publications of the Office of the Chief Actuary of the Social Security Administration); (ii) provides for payments to be made in equal amounts during the term of the loan, with no deferral and no balloon payments made; and (iii) prohibits the cancellation of the balance upon the death of the lender.

Source page · Official code · as of current statute · retrieved 2026-11-04

Life estatesVerified source
Buying a life estate in someone else's home is a transfer unless the buyer lives in the home at least 1 year after purchase.
Where this comes from

42 U.S.C. 1396p(c)(1)(J)

the term "assets" includes the purchase of a life estate interest in another individual's home unless the purchaser resides in the home for a period of at least 1 year after the date of the purchase.

Source page · Official code · as of current statute · retrieved 2026-11-04

Life estates retained when a parent deeds the remainder to children are still a transfer of the remainder interest (look-back applies) and may be reached by expanded estate recovery; see estateRecovery.optionalExpandedEstate.

Estate recovery › mandatoryVerified source
States MUST recover from the estates of people who were 55+ when they received Medicaid, at least for nursing facility services, HCBS, and related hospital and prescription drug services; states may optionally recover for any other Medicaid services.
Where this comes from

42 U.S.C. 1396p(b)(1)(B)

In the case of an individual who was 55 years of age or older when the individual received such medical assistance, the State shall seek adjustment or recovery from the individual's estate, but only for medical assistance consisting of— (i) nursing facility services, home and community-based services, and related hospital and prescription drug services, or (ii) at the option of the State, any items or services under the State plan

Source page · Official code · as of current statute · retrieved 2026-11-04

Estate recovery › probate estateVerified source
At minimum, 'estate' means the probate estate as defined by state law.
Where this comes from

42 U.S.C. 1396p(b)(4)(A)

shall include all real and personal property and other assets included within the individual's estate, as defined for purposes of State probate law

Source page · Official code · as of current statute · retrieved 2026-11-04

Estate recovery › optional expanded estateVerified source
States may expand 'estate' to non-probate assets: joint tenancy, tenancy in common, survivorship, life estate, living trust, and other arrangements.
Where this comes from

42 U.S.C. 1396p(b)(4)(B)

may include, at the option of the State (and shall include, in the case of an individual to whom paragraph (1)(C)(i) applies), any other real and personal property and other assets in which the individual had any legal title or interest at the time of death (to the extent of such interest), including such assets conveyed to a survivor, heir, or assign of the deceased individual through joint tenancy, tenancy in common, survivorship, life estate, living trust, or other arrangement.

Source page · Official code · as of current statute · retrieved 2026-11-04

Partnership LTC policyholders (1396p(b)(1)(C)(i)) are subject to the expanded definition for non-protected assets.

Estate recovery › deferralsVerified source
Recovery only after death of surviving spouse and only when there is no surviving child under 21 or blind/disabled; undue hardship waivers required.
Where this comes from

42 U.S.C. 1396p(b)(2)-(3)

Any adjustment or recovery under paragraph (1) may be made only after the death of the individual's surviving spouse, if any, and only at a time— (A) when he has no surviving child who is under age 21, or (with respect to States eligible to participate in the State program established under subchapter XVI) is blind or per manently and totally disabled

Source page · Official code · as of current statute · retrieved 2026-11-04

Quote reproduces a line-break artifact ('per manently') present in the govinfo HTML. Hardship: '(3)(A) The State agency shall establish procedures ... under which the agency shall waive the application of this subsection (other than paragraph (1)(C)) if such application would work an undue hardship'.

Trusts › miller trust qitVerified source
Income-only trust (pension, Social Security, other income) with state payback at death; used in states that cap institutional income at 300% of SSI and do not have a medically needy program for nursing facility services.
Where this comes from

42 U.S.C. 1396p(d)(4)(B)

A trust established in a State for the benefit of an individual if— (i) the trust is composed only of pension, Social Security, and other income to the individual (and accumulated income in the trust), (ii) the State will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State plan under this subchapter; and (iii) the State makes medical assistance available to individuals described in section 1396a(a)(10)(A)(ii)(V) of this title, but does not make such assistance available to individuals for nursing facility services under section 1396a(a)(10)(C) of this title.

Source page · Official code · as of current statute · retrieved 2026-11-04

Trusts › first party sntVerified source
(d)(4)(A) trust for a disabled person under 65 with Medicaid payback.
Where this comes from

42 U.S.C. 1396p(d)(4)(A)

A trust containing the assets of an individual under age 65 who is disabled (as defined in section 1382c(a)(3) of this title) and which is established for the benefit of such individual by the individual, a parent, grandparent, legal guardian of the individual, or a court if the State will receive all amounts remaining in the trust upon the death of such individual up to an amount equal to the total medical assistance paid on behalf of the individual under a State plan under this subchapter.

Source page · Official code · as of current statute · retrieved 2026-11-04

Trusts › pooled trustVerified source
(d)(4)(C) pooled trust run by a nonprofit; no age cap in the trust exception itself, but transfers into it by a person 65+ can be penalized as a transfer in many states (transfer exemption 1396p(c)(2)(B)(iv) covers only under-65 beneficiaries).
Where this comes from

42 U.S.C. 1396p(d)(4)(C)

A trust containing the assets of an individual who is disabled (as defined in section 1382c(a)(3) of this title) that meets the following conditions: (i) The trust is established and managed by a non-profit association. (ii) A separate account is maintained for each beneficiary of the trust, but, for purposes of investment and management of funds, the trust pools these accounts.

Source page · Official code · as of current statute · retrieved 2026-11-04

Treatment of pooled-trust funding by people 65+ varies by state; check state files.

Partnership ltc insuranceVerified source
Qualified State Long-Term Care Insurance Partnership: assets equal to benefits paid by a qualifying Partnership LTC policy are disregarded for Medicaid eligibility and protected from estate recovery. Policy must be issued while a resident of a Partnership state.
Where this comes from

42 U.S.C. 1396p(b)(1)(C)(iii) (DRA 2005)

the term "qualified State long-term care insurance partnership" means an approved State plan amendment under this subchapter that provides for the disregard of any assets or resources in an amount equal to the insurance benefit payments that are made to or on behalf of an individual who is a beneficiary under a long-term care insurance policy if the following requirements are met: (I) The policy covers an insured who was a resident of such State when coverage first became effective under the policy.

Source page · Official code · as of current statute · retrieved 2026-11-04

Medicare savings programs2026Verified source
Qmb
Income individual
$1,350/month (income); USD (resources)
Income couple
$1,824/month (income); USD (resources)
Slmb
Income individual
$1,616/month (income); USD (resources)
Income couple
$2,184/month (income); USD (resources)
Qi
Income individual
$1,816/month (income); USD (resources)
Income couple
$2,455/month (income); USD (resources)
Resource individual
$9,950/month (income); USD (resources)
Resource couple
$14,910/month (income); USD (resources)
Qdwi
Resource individual
$4,000/month (income); USD (resources)
Resource couple
$6,000/month (income); USD (resources)
Where this comes from
Monthly income and resource limits for 2026: Your situation: Monthly income limit:* Resource limit: What counts in resource limits? Individual $1,350 $9,950 Married couple $1,824 $14,910

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

QMB shown in quote. Same page: SLMB 'Individual $1,616 $9,950 Married couple $2,184 $14,910'; QI 'Individual $1,816 $9,950 Married couple $2,455 $14,910'. '* Income limits slightly higher in Alaska and Hawaii.' Resource limits confirmed by CMCS CIB Dec. 9, 2025: 'Effective January 1, 2026, the resource standards for single and married QMBs, SLMBs, and QIs will be, respectively, $9,950 and $14,910.' QDWI resource standard 'remains $4,000 for a single individual and $6,000 for a married individual.' Many states use higher limits or no asset test.

Ambulance (federal)

Medicare part bVerified source
Covered when other transport would endanger health; patient pays 20% after Part B deductible; to nearest appropriate facility; air only when ground can't provide rapid transport.
Where this comes from
Part B covers ground ambulance transportation when traveling in any other vehicle could endanger your health, and you need medically necessary services from one of the following: A hospital A critical access hospital A rural emergency hospital A skilled nursing facility

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Medical necessityVerified source
Other transport must be contraindicated; non-emergency transport allowed if bed-confined (cannot get up, walk, or sit in chair/wheelchair) or otherwise medically required; scheduled repetitive non-emergency transport requires a physician certification statement dated within 60 days.
Where this comes from

42 CFR 410.40(e)(1)-(2); 410.41 (vehicle/staff)

Medicare covers ambulance services, including fixed wing and rotary wing ambulance services, only if they are furnished to a beneficiary whose medical condition is such that other means of transportation are contraindicated.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

DestinationVerified source
Nearest hospital/CAH/REH/SNF capable of required care; hospital/SNF to home; SNF to nearest supplier of services not available at the SNF; dialysis rules.
Where this comes from

42 CFR 410.40(f)

From any point of origin to the nearest hospital, CAH, rural emergency hospital (REH), or SNF that is capable of furnishing the required level and type of care for the beneficiary's illness or injury.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

If the patient chooses a farther facility, Medicare generally pays only the mileage to the nearest appropriate one.

AbnVerified source
Ambulance supplier must give an ABN for non-emergency transport it expects Medicare won't pay; without a valid ABN the supplier generally can't bill the beneficiary.
Where this comes from
The ambulance company must give you an "Advance Beneficiary Notice of Noncoverage (ABN)" when both of these apply: You get ambulance services in a non-emergency situation. The ambulance company believes that Medicare may not pay for your specific ambulance service.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Repetitive scheduled prior authVerified source
Prior authorization for repetitive scheduled non-emergent ambulance transports (3+ round trips in 10 days or weekly for 3+ weeks), nationwide; if denied and service continues, beneficiary can be billed.
Where this comes from
If your prior authorization request isn't approved and you continue getting these services, Medicare will deny the claim and the ambulance company may bill you for all charges.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: 'You get scheduled, non-emergency ambulance transportation for 3 or more round trips in a 10-day period or at least once a week for 3 weeks or more You get this transportation from any ambulance company nationwide'.

No surprises act scopeVerified source
Air ambulance
covered
Ground ambulance
NOT covered (unless state law)
Where this comes from
Generally, ground ambulance services aren't covered by billing protections in the No Surprises Act (unless a state law has different rules). They're still allowed to charge out-of-network rates.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Same page: the NSA protects against surprise out-of-network bills from 'emergency room visits; non-emergency care related to visits at in-network hospitals, hospital outpatient departments, and ambulatory surgical centers; and air ambulance services.' NSA applies to private/commercial coverage; Medicare and Medicaid already limit balance billing by participating ambulance suppliers.

Gapb committeeVerified source
Report issued
2024-08-28 (report document dated March 29, 2024)
Status
Currently Inactive
Where this comes from
The Committee issued its Report to the Secretaries containing Recommendations on preventing balance billing for ground ambulance services and protecting consumers on August 28, 2024. Committee Status - Currently Inactive

Source page · Agency guidance · as of 2026-11 · retrieved 2026-11-04

Report PDF: https://www.cms.gov/files/document/report-advisory-committee-ground-ambulance-and-patient-billing.pdf (recommends prohibiting ground-ambulance balance billing with cost-sharing caps; not self-executing).

Federal ground ambulance legislationLikely
Enacted
No
Where this comes from
Committee Status - Currently Inactive

Source page · Agency guidance · as of 2026-11-04 · retrieved 2026-11-04

No enacted federal law extending NSA-style protection to ground ambulances was found as of 2026-11-04 (CMS consumer page still says ground ambulance is generally not covered). Could not confirm any pending 119th Congress consumer-protection bill; the 119th-Congress 'Protecting Access to Ground Ambulance Medical Services Act' (H.R. 2232 / S. 1643) concerns Medicare rate add-ons, not balance billing. State laws fill the gap; see state files.

Medicaid nemtVerified source
States must ensure necessary transportation to and from providers for Medicaid beneficiaries and describe their methods (often a broker).
Where this comes from

42 CFR 431.53; 42 U.S.C. 1396a(a)(4)(A)

A State plan must— ( a ) Specify that the Medicaid agency will ensure necessary transportation for beneficiaries to and from providers; and ( b ) Describe the methods that the agency will use to meet this requirement.

Source page · Official regulation · as of current regulation · retrieved 2026-11-04

eCFR spacing artifacts '( a )' kept as rendered. Statute 1396a(a)(4) likewise requires the state agency to 'ensure necessary transportation for beneficiaries under the State plan to and from providers'.

Taxes

Medical expense thresholdVerified source
0.075
Where this comes from

IRC 213(a); IRS Pub. 502 (2025)

You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 7.5% of your adjusted gross income (AGI).

Source page · Agency guidance · as of 2025 · retrieved 2026-11-04

Pub 502 for tax year 2026 not yet published; 7.5% floor is permanent in IRC 213(a). Nursing home: 'This includes the cost of meals and lodging in the home if a principal reason for being there is to get medical care.' Qualified long-term care services for a chronically ill person are also includible.

Ltc premium limitsVerified source
Age40 or less
$500/year per person
41to50
$930/year per person
51to60
$1,860/year per person
61to70
$4,960/year per person
Over70
$6,200/year per person
Where this comes from

Rev. Proc. 2025-32 sec. 4.27; IRC 213(d)(10)

Attained Age Before the Close of the Taxable Year Limitation on Premiums 40 or less $500 More than 40 but not more than 50 $930 More than 50 but not more than 60 $1,860 More than 60 but not more than 70 $4,960 More than 70 $6,200

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Only the portion within these limits counts as a medical expense (still subject to the 7.5%-of-AGI floor). 2027 limits not located as of 2026-11-04.

Ltc per diem limitVerified source
$430/day
Where this comes from

Rev. Proc. 2025-32 sec. 4.62

For calendar year 2026, the stated dollar amount of the per diem limitation under § 7702B(d)(4), regarding periodic payments received under a qualified long-term care insurance contract or periodic payments received under a life insurance contract that are treated as paid by reason of the death of a chronically ill individual, is $430.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Parent as dependentVerified source
Qualifying relative gross income limit2026
$5,300
Parent need not live with you
Yes
Support test
you must provide more than half of support (or use a multiple support agreement)
Where this comes from

Rev. Proc. 2025-32 sec. 4.23; IRC 152(d); IRS Pub. 501

For taxable years beginning in 2026, the exemption amount referred to in § 152(d)(1)(B) is $5,300.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Pub 501 lists 'Your father, mother, grandparent, or other direct ancestor, but not foster parent' among relatives who need not live with you. Social Security that is not taxable generally isn't gross income for this test (check Pub 501). Pub 502: you may deduct medical expenses paid for a parent who would be your dependent except for the gross-income test.

Head of household parentVerified source
You can file as head of household if you pay more than half the cost of keeping up your dependent parent's main home, including a nursing/rest home, even if the parent doesn't live with you.
Where this comes from

IRS Pub. 501 (2025)

If you pay more than half the cost of keeping your parent in a rest home or home for the elderly, that counts as paying more than half the cost of keeping up your parent’s main home.

Source page · Agency guidance · as of 2025 · retrieved 2026-11-04

Dependent care credit parentVerified source
Care costs for a parent who is physically or mentally unable to care for themselves and lived with you more than half the year can qualify for the child and dependent care credit (so you can work).
Where this comes from

IRS Pub. 503 (2025); IRC 21

A person who wasn't physically or mentally able to care for themselves, lived with you for more than half the year, and either: Was your dependent, or Would have been your dependent except that: They received gross income of $5,200 or more

Source page · Agency guidance · as of 2025 · retrieved 2026-11-04

2025 publication shows the 2025 gross income figure ($5,200); 2026 figure is $5,300 per Rev. Proc. 2025-32.

Senior deductionVerified source
Per person
6,000
Married both eligible
12,000
Years
2025-2028
Where this comes from

Pub. L. 119-21; IRS Pub. 501 (2025)

Beginning in 2025, taxpayers who are age 65 or older may be eligible for the enhanced deduction for seniors. The maximum amount of the deduction is $6,000 ($12,000 if married filing jointly and both spouses are eligible).

Source page · Agency guidance · as of 2025 · retrieved 2026-11-04

Income phase-out applies; OBBBA provides it for tax years 2025-2028 (end year not quoted from the fetched page).

Gift vs inherit basisVerified source
Gift
carryover basis (donor's adjusted basis) when FMV >= donor basis
Inheritance
basis generally = FMV at date of death (step-up)
Where this comes from

IRC 1015 (gifts), 1014 (inherited); IRS Pub. 551

If the FMV of the property is equal to or greater than the donor's adjusted basis, your basis is the donor's adjusted basis at the time you received the gift.

Source page · Agency guidance · as of 2026 · retrieved 2026-11-04

Inherited: 'Generally, the basis of property inherited from a decedent is one of the following. The FMV of the property at the date of the individual's death.' Why it matters: a house bought for $80k and gifted to a child while worth $400k carries the $80k basis; if the child sells, ~$320k gain is taxable (and the child usually can't use the parent's IRC 121 exclusion). If inherited instead, basis steps up to ~$400k and little or no gain results. Gifting also starts a 60-month Medicaid look-back penalty.

Home sale exclusionVerified source
Single
$250,000
Married joint
$500,000
Where this comes from

IRC 121; IRS Pub. 523

If you meet certain conditions, you may exclude the first $250,000 of gain from the sale of your home from your income and avoid paying taxes on it. The exclusion is increased to $500,000 for a married couple filing jointly.

Source page · Agency guidance · as of 2025 · retrieved 2026-11-04

Gain above the exclusion raises MAGI and can trigger IRMAA two years later.

What we couldn't confirm