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Elder care in Louisiana
Do I (or a relative) qualify for Medicaid? Quick check
Answer yes or no to each question for a rough first answer. The figures are Louisiana's.
Each question says what a yes and a no mean.
Not legal advice. Figures are for 2026. The final decision is the state's: Louisiana Department of Health (LDH). The requirements in full: Qualifying for Medicaid in Louisiana.
Read these first
Over the $2,982 income limit? Louisiana uses spend-down, not a Miller trust
Louisiana residents in a nursing home with income above the Special Income Limit can still qualify through the LTC Spend-Down Medically Needy program, using the projected Medicaid facility rate as a medical expense. But if income exceeds even the facility rate ('Income over Facility Fee') Medicaid gives coverage with no vendor payment to the nursing home. Don't pay for a QIT that Louisiana doesn't use.
Source and quote
Louisiana Medicaid Eligibility Manual H-1040
LTC SD MNP/Income over Facility Fee certifications are not eligible for vendor payment.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Spouse keeps the full $162,660, but the assets must be retitled
Louisiana protects the whole Spousal Resource Standard (not half). The allocated assets must actually be moved into the community spouse's name by the first renewal; transfers beyond the allocation are penalized.
Source and quote
Louisiana Medicaid Eligibility Manual I-1660
Amounts in excess of the allocated resource transferred to the community spouse by the institutionalized spouse or by the community spouse themselves shall be considered under the transfer provisions.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
At-home spouse income floor is the federal maximum
Louisiana sets the spouse's maintenance needs at $4,066.50/month (the federal cap) for everyone, so more of the nursing-home spouse's income can be diverted to the at-home spouse than in min/max states.
Source and quote
Louisiana Medicaid Eligibility Manual Z-800
01/01/2026 – 06/30/2026 $4,066.50 $2,643.75
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Estate recovery is probate-only with a homestead floor and heir hardship rule
LDH recovers only from the succession (probate) estate, cannot recover the first $15,000 or half the parish median homestead value, and must waive when an heir's family income is at or below 300% of the poverty level. Heirs should ask for the hardship waiver and document homestead upkeep costs, which can reduce the claim.
Source and quote
La. R.S. 46:153.4(F)(2)
An undue hardship to any heir, as defined by rule, shall exist if an heir’s family income is three hundred percent or less of the applicable federal poverty guideline as published in the Federal Register by the United States Department of Health and Human Services.
Source page · Official code · as of 2018 · retrieved 2026-11-04
Ground-ambulance protection has gaps
Louisiana bans balance billing for out-of-network emergency ground ambulance only under state-regulated plans (and self-funded governmental plans). Private self-funded employer plans, non-emergency transports, Medicare and air ambulance fall outside it. Check plan type before paying an ambulance bill.
Source and quote
La. R.S. 22:1880.2(A)(6)
(e) A sponsor of self-funded governmental plan.
Source page · Official code · as of 2023 · retrieved 2026-11-04
Medigap birthday rule only lets you stay with the same company
The 63-day birthday window lets a policyholder switch to an equal-or-lesser plan with the same insurer or its affiliate. It does not let you shop other companies without medical underwriting.
Source and quote
La. R.S. 22:1112(A)(2)
a standardized policy identified by a plan letter indicating benefits that are equal to or less than the benefits indicated by the plan letter of the individual's previous Medicare supplement policy
Source page · Official code · as of 2023 · retrieved 2026-11-04
Transfer penalty starts the month after the gift
Louisiana's penalty clock starts the first of the month after the transfer (or when the person is otherwise eligible and in care, if later), and multiple gifts are lumped into one penalty. The divisor in the Oct. 2025 manual is $7,200/month ($236.71/day) for applications since Sept. 1, 2024, so each $7,200 given away costs about a month of nursing-home coverage. Confirm the current figure with LDH before planning gifts.
Source and quote
LA State Plan Supplement 9(a) to Att. 2.6-A, item 6
The state adds together all transfers for less than fair market value made during the look-back period in more than one month and calculates a single period of ineligibility, that begins on the earliest date that would otherwise apply if the transfer had been made in a single lump sum.
Source page · Agency form · as of 2020 · retrieved 2026-11-04
Adult children owe 'basic necessities' including health care
Louisiana Civil Code art. 237 makes descendants responsible for a needy parent's food, clothing, shelter and health care when the parent can't get them elsewhere. It is civil and rarely used, but it exists.
Source and quote
La. Civ. Code art. 237
This obligation is owed by descendants and ascendants in the order of their degree of relationship to the obligee and is joint and divisible among obligors.
Source page · Official code · as of 2016 · retrieved 2026-11-04
Paying a relative for past care counts as a gift
Louisiana treats payments under a caregiver (personal care) agreement as a transfer unless the agreement was written before the care started, spells out services, hours and pay, pays within 30 days at local market rates, and the caregiver is not a spouse or parent. Any payment for care a relative already gave for free is a penalized transfer, and the agreement ends when the parent enters a nursing facility. Sign the agreement before care begins and keep logs.
Source and quote
LA Medicaid Eligibility Manual I-1673.10
Therefore, any payment to a relative for care provided for free in the past is a transfer of assets for less than fair market value.
Archived copy · Official page · Agency guidance · as of 2025-10 · retrieved 2026-11-04
Listing the house for sale ends the home exemption
A nursing-home resident's house stays exempt on 'intent to return', but once it is offered for sale it is no longer excludable on that basis (unless a spouse or dependent relative lives there or another exclusion applies). Putting the home into a revocable or irrevocable trust also makes it countable.
Source and quote
LA Medicaid Eligibility Manual I-1630
If the home property is offered for sale, it is no longer excludable based on intent to return.
Archived copy · Official page · Agency guidance · as of 2024-09-23 · retrieved 2026-11-04
At a glance
Calculators for Louisiana Compare states
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 Louisiana
Giving away $50,000 in Louisiana ≈ 6.94 months without nursing-home coverage
$50,000 ÷ $7,200 a month (the penalty divisor). The penalty starts only once the person is otherwise eligible (see the next mistake).
Source and quote
LA Medicaid Eligibility Manual I-1676.1 (reissued Oct. 21, 2025)
For applications received on or after September 1, 2024 the average monthly private pay rate used as the divisor in determining a transfer of assets penalty period is $7,200.00 ($236.71 per day).
Archived copy · Official page · Agency guidance · as of 2025-10 · retrieved 2026-11-04
Newest readable archive copy of I-1670 is Oct. 31, 2025 (the Feb. 2026 capture is a redirect and the Sept. 2026 capture is a 403). $7,200 was still current in that version; a 2026 revision cannot be ruled out. Earlier divisors: $6,500 (1/1/2024), $5,000 (3/1/2018). Partial months are penalized. When assets are returned, the divisor in place when the penalty was assessed is reused.
Source and quote
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
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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
Source and quote
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.
Source and quote
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
Source and quote
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
Source and quote
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).
Source and quote
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
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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 Louisiana specifically
- Over the $2,982 income limit? Louisiana uses spend-down, not a Miller trust
- Spouse keeps the full $162,660, but the assets must be retitled
- At-home spouse income floor is the federal maximum
- Estate recovery is probate-only with a homestead floor and heir hardship rule
- Ground-ambulance protection has gaps
- Medigap birthday rule only lets you stay with the same company
- Transfer penalty starts the month after the gift
- Adult children owe 'basic necessities' including health care
- Paying a relative for past care counts as a gift
- Listing the house for sale ends the home exemption
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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).
Source and quote
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
Source and quote
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
- Medicaid agency
Louisiana Department of Health (LDH) (Louisiana Medicaid (Healthy Louisiana)) - Free Medicare counseling (SHIP)
LaSHIP - Louisiana Senior Health Information Program (LDI) · 1-800-259-5300 - Aging services
LDH Office of Aging and Adult Services (OAAS); Louisiana Options in Long Term Care 1-877-456-1146 - Insurance regulator
Louisiana Department of Insurance (LDI)
Eligibility figures and notes
Source and quote
Louisiana Medicaid Eligibility Manual H-1040
A person who resides in a long-term care (LTC) facility who meets all other eligibility requirements, but has income over the Special Income Limit (SIL) may be eligible for LTC SD MNP.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Special Income Limit (300% SSI) plus a Long Term Care Spend-Down Medically Needy Program using the projected Medicaid facility rate as an incurred expense. No Miller trust needed.
Source and quote
Louisiana Medicaid Eligibility Manual Z-700
1/1/26 $2,982.00 $5,964.00 $2,000.00 $3,000.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Z-700 table row (SIL individual, SIL couple, resource individual, resource couple). Reissued January 7, 2026. Income above this can still qualify via LTC spend-down (H-1040).
Source and quote
Louisiana Medicaid Eligibility Manual H-1040
The person must incur medical expenses in an amount which is equal to or greater than their monthly excess income to meet spend-down.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Inferred: Louisiana uses LTC spend-down rather than a Qualified Income Trust for income over the SIL. No LDH text explicitly saying 'no QIT' was fetched.
Source and quote
Louisiana Medicaid Eligibility Manual Z-700
1/1/26 $2,982.00 $5,964.00 $2,000.00 $3,000.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Source and quote
Louisiana Medicaid Eligibility Manual Z-700
1/1/26 $2,982.00 $5,964.00 $2,000.00 $3,000.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Source and quote
Louisiana Medicaid Eligibility Manual Z-700
LTC Personal Care Needs Allowance $45.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Effective July 1, 2025 (raised from $38 via SPA LA-25-0013, approved Nov 3, 2025). HCBS maintenance allowance is 3 x SSI FBR. Optional state supplement up to $15.
Source and quote
LA Medicaid Eligibility Manual Z-2300 (issued Dec. 2, 2025); I-1630
2026 $752,000.00
Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04
Quote is the 2026 row of the Z-2300 'Home Equity Limits by Year' table (whitespace collapsed). Louisiana uses the federal minimum. Per I-1630 the limit does not apply if a spouse, child under 21, or blind/disabled child lives in the home; HCBS waiver applicants over the limit are ineligible for waiver services; undue-hardship exception available (H-860).
Source and quote
LA Medicaid Eligibility Manual I-1630 (Home Property), reissued Sept. 23, 2024
If the home property is offered for sale, it is no longer excludable based on intent to return.
Archived copy · Official page · Agency guidance · as of 2024-09-23 · retrieved 2026-11-04
Also: 'Home property placed in a revocable or irrevocable trust loses the exclusion as a home property and becomes a countable resource.' Manual says not to rely on Homestead Exemption status.
Source and quote
Louisiana Medicaid Eligibility Manual I-1660
Determine total countable resources within 45 days of the request for assessment.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Protecting the spouse at home
Source and quote
Louisiana Medicaid Eligibility Manual I-1660
Subtract the appropriate spousal impoverishment maximum protected resource amount from countable couple resources to determine the countable resources of the LTC/HCBS/ACH institutionalized spouse.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Couple must actually move allocated resources into the community spouse's name by the first renewal.
Source and quote
Louisiana Medicaid Eligibility Manual I-1660
The maximum allowable amount of a couple's combined countable resources which may be allocated for the use and maintenance of the community spouse.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Louisiana publishes a single Spousal Resource Standard ($162,660 for 2026 admissions) with no separate minimum; the community spouse is allowed the full standard (100% method). Value null because no separate minimum exists.
Source and quote
Louisiana Medicaid Eligibility Manual Z-800
1/1/2026 – 12/31/2026 $162,660.00
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Source and quote
Louisiana Medicaid Eligibility Manual Z-800
01/01/2026 – 06/30/2026 $4,066.50 $2,643.75
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches. Louisiana uses a single 'Spouse's Maintenance Needs' figure equal to the federal maximum ($4,066.50) rather than a min/max range, so min = max. $2,643.75 is the dependent's maintenance-needs figure. Table issued Dec 3, 2025 covers 1/1/2026-6/30/2026; no later row was available.
Source and quote
Louisiana Medicaid Eligibility Manual Z-800
01/01/2026 – 06/30/2026 $4,066.50 $2,643.75
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Fetched from an Internet Archive (Wayback) copy of the official LDH Medicaid Eligibility Manual page because ldh.la.gov returns HTTP 403 to automated fetches.
Gifts, the look-back and the penalty
Source and quote
LA Medicaid Eligibility Manual I-1676.3 (reissued Oct. 21, 2025)
The look-back period begins with the look-back date and ends with the baseline date, which is the 60 months (five years) prior to applying for Medicaid.
Archived copy · Official page · Agency guidance · as of 2025 · retrieved 2026-11-04
- Monthly
- $7,200/month
- Daily
- $236.71/month
- Effective
- applications received on or after 2024-09-01
Source and quote
LA Medicaid Eligibility Manual I-1676.1 (reissued Oct. 21, 2025)
For applications received on or after September 1, 2024 the average monthly private pay rate used as the divisor in determining a transfer of assets penalty period is $7,200.00 ($236.71 per day).
Archived copy · Official page · Agency guidance · as of 2025-10 · retrieved 2026-11-04
Newest readable archive copy of I-1670 is Oct. 31, 2025 (the Feb. 2026 capture is a redirect and the Sept. 2026 capture is a 403). $7,200 was still current in that version; a 2026 revision cannot be ruled out. Earlier divisors: $6,500 (1/1/2024), $5,000 (3/1/2018). Partial months are penalized. When assets are returned, the divisor in place when the penalty was assessed is reused.
Source and quote
LA State Plan Supplement 9(a) to Att. 2.6-A, item 3 (TN 20-0016, eff. Oct 1, 2020)
X The State uses the first day of the month after the month in which the assets were transferred
Source page · Agency form · as of 2020 · retrieved 2026-11-04
Multiple transfers are added together into a single penalty period.
Source and quote
LA Medicaid Eligibility Manual I-1673.10, I-1674 (reissued Oct. 21, 2025)
Provided care to the individual allowing the individual to reside at home, rather than in an institution or facility.
Archived copy · Official page · Agency guidance · as of 2025-10 · retrieved 2026-11-04
PCA rule quote: 'Therefore, any payment to a relative for care provided for free in the past is a transfer of assets for less than fair market value.' A PCA ends at nursing-facility admission.
After death: estate recovery and liens
Source and quote
La. R.S. 46:153.4(D)
The Louisiana Department of Health shall establish an estate recovery program for the purpose of recovering medical assistance payments made on behalf of individual recipients from the succession estates of those individuals. The department shall seek recovery of medical assistance payments for only those instances mandated by Subchapter XIX of the Social Security Act, 42 U.S.C. 1396p, as amended.
Source page · Official code · as of 2018 · retrieved 2026-11-04
Recovery limited to the succession (probate) estate and to federally mandated instances.
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Whether LDH files pre-death TEFRA liens not found; LDH pages blocked.
Source and quote
La. R.S. 46:153.4(E)-(G)
The department shall not institute estate recovery on the first fifteen thousand dollars or one-half the median value of the homestead in each parish whichever is higher.
Source page · Official code · as of 2018 · retrieved 2026-11-04
Statute also: 'An undue hardship to any heir, as defined by rule, shall exist if an heir’s family income is three hundred percent or less of the applicable federal poverty guideline'.
Source and quote
Protected assets are not considered in
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Quote is truncated at a column break in the LDI brochure; the LAC rule saying the department shall not seek recovery of the disregarded amount was seen only in search snippets.
Family liability
Source and quote
La. Civ. Code art. 237 (Acts 2015, No. 260, eff. Jan. 1, 2016)
Descendants are bound to provide the basic necessities of life to their ascendants who are in need, upon proof of inability to obtain these necessities by other means or from other sources, and ascendants are likewise bound to provide for their needy descendants, this obligation being reciprocal. This obligation is strictly personal and is limited to the basic necessities of food, clothing, shelter, and health care.
Source page · Official code · as of 2016 · retrieved 2026-11-04
Civil obligation only; Louisiana's criminal neglect-of-family statute (R.S. 14:74) covers spouses and minor children, not parents. 'Strictly personal' (parent must claim it). Obligation secondary to a spouse's. 'enforced: rare' is a judgment; no recent provider suits found.
Care at home and other programs
- Community Choices Waiver (CCW) Waitlist
Age 65+ and adults 21-64 with physical disabilities meeting nursing-facility level of care - Adult Day Health Care (ADHC) Waiver
Adult day health care for nursing-facility-level adults - Long Term-Personal Care Services (LT-PCS) (state plan, not a waiver)
In-home personal care
Source and quote
For more info, contact Louisiana Options in Long Term-Care at 1-877-456-1146 .
Archived copy · Official page · Agency guidance · as of 2026 · retrieved 2026-11-04
The July 10, 2026 archive copy of the OAAS CCW page lists CCW services (personal assistance, ADHC, home-delivered meals, respite, nursing, Monitored In-Home Caregiving, nursing-home transition services) and the 1-877-456-1146 contact, but says nothing about a waiting list or the Request for Services Registry size. Waitlist status (and ~11,800 waiting reported in 2026 news snippets) remains unverified.
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Not verified. Could not fetch OAAS waiver service lists.
Source and quote
LDH OAAS RFI OAAS-ADM-26-021 (issued July 27, 2026)
Currently there are PACE organizations serving the Greater New Orleans area, the Greater Lafayette area, East Baton Rouge Parish, West Baton Rouge Parish, Avoyelles Parish and Rapides Parish; a PACE organization is pending in the greater Shreveport area.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Source and quote
LDI Louisiana Long-Term Care Partnership Program brochure
Without a Partnership plan, a person would have to “spend down” all but $2,000 of their assets before applying for Medicaid.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Program implemented via LDI Bulletin 09-13 (2009, per search results; not fetched). Dollar-for-dollar disregard; reciprocity with other states reported in search snippets. Quote is from a two-column brochure; PDF text extraction interleaves columns.
Medicare and Medigap
- Description
- Existing Medigap policyholders get a 63-day window starting on their birthday each year to buy a policy from the SAME insurer or an affiliate, with no underwriting, if the new plan letter has equal or lesser benefits.
Source and quote
La. R.S. 22:1112(A) (Acts 2022, No. 459; Acts 2023, No. 71)
the individual shall have an annual open enrollment period commencing with the individual's birthday and lasting for a period of sixty-three calendar days, during which the individual may purchase any Medicare supplement policy offered by the same issuer or any affiliate authorized to transact business in this state.
Source page · Official code · as of 2023 · retrieved 2026-11-04
Does NOT allow moving to a different, unaffiliated company. Issuers must notify policyholders of the window at application.
Source and quote
La. R.S. 22:1112
No quote captured.
Source page · Official code · as of 2026 · retrieved 2026-11-04
No year-round guaranteed issue. R.S. 22:1112(B) adds a 63-day guaranteed-issue window when someone who kept employer coverage at Medicare eligibility leaves/loses that employer plan.
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Secondary sources say Louisiana requires insurers to offer Medigap to under-65 beneficiaries (possibly at higher premiums); no statute or LDI page fetched to confirm.
- Qmb_income_individual
- 1,330
- Qmb_income_couple
- 1,804
- Asset test
- not applicable (eliminated)
- Note
- Income figures exclude the $20 disregard
Source and quote
LDI LaSHIP 'Save Money on Medicine and Medicare Costs' 2026
Asset Limit: Individual = not applicable
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Louisiana has no resource test for QMB (and per secondary sources SLMB/QI). SLMB/QI income limits not extracted.
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Not researched.
Ambulance bills and rides
- Scope
- Out-of-network EMERGENCY ambulance (not air) under state-regulated health plans, including self-funded governmental plans. Insurer pays the local-government-set rate, or if none, the lesser of 325% of Medicare or billed charges; provider may not balance bill beyond in-network cost sharing. Does not reach ERISA self-funded employer plans or Medicare.
- Effective
- 2023-08-01
Source and quote
La. R.S. 22:1880.2 (Acts 2023, No. 453, SB 109)
Payment made in compliance with this Section shall be considered payment in full for the covered services provided, except for any copayment, coinsurance, deductible, and other cost-sharing amounts required to be paid by the enrollee. An ambulance provider is prohibited from billing the enrollee for any additional amounts for paid covered services.
Source page · Official code · as of 2023 · retrieved 2026-11-04
Quote joins text across a page break of the enrolled act. Effective date 8/1/2023 from the bill digest. Non-emergency transports are not covered. Enrolled act PDF has line numbers in the margin.
Source and quote
La. R.S. 22:1880.2(A)(1)
For purposes of this Section, "ambulance provider" does not include an air ambulance provider.
Source page · Official code · as of 2023 · retrieved 2026-11-04
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
NEMT booking details not fetched (Healthy Louisiana plans arrange rides; LDH pages blocked).
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
Not researched.
Other protections
Source and quote
No quote captured.
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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.
Source and quote
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)
Source and quote
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
- Days61to90
- $434/day
- Lifetime reserve per day
- $868/day
Source and quote
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
- Premium free if40 quarters
- $0/month
- Reduced30to39 quarters
- $311/month
- Full
- $565/month
Source and quote
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
Source and quote
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.
Source and quote
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
- Days1to20
- $0/day
- Days21to100 per day
- $217/day
- After100
- beneficiary pays all costs
Source and quote
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.
Source and quote
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
Source and quote
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.
Source and quote
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
Source and quote
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
Source and quote
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.
- 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
Source and quote
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.
Source and quote
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.
- 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
Source and quote
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'.
- 2026
- $2,100/year
- 2027
- $2,400/year
Source and quote
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).
Source and quote
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.
- 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
Source and quote
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.
Source and quote
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
Source and quote
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).
Source and quote
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
Source and quote
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).'
Source and quote
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)
Source and quote
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.
Source and quote
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
Source and quote
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.
Source and quote
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
- Individual
- $2,000
- Couple
- $3,000
Source and quote
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.
Source and quote
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.
Source and quote
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).
- Individual
- $30/month
- Couple
- $60/month
Source and quote
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).
Source and quote
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
Source and quote
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
- 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
Source and quote
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.
Source and quote
Maximum Monthly Maintenance Needs Allowance: 4,066.50
Source page · Agency guidance · as of 2026 · retrieved 2026-11-04
- 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
Source and quote
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.
Source and quote
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
Source and quote
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
Source and quote
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
Source and quote
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
Source and quote
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
- Effective
- 2028-01-01
- Non agricultural home cap
- 1,000,000
- Indexed
- No
- Agricultural lot homes
- keep the existing indexed state-option range
Source and quote
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.
- 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
Source and quote
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'.
Source and quote
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.
Source and quote
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
Source and quote
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
Source and quote
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.
- 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
Source and quote
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).
- 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)
Source and quote
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.'
Source and quote
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
Source and quote
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.
Source and quote
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
Source and quote
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
Source and quote
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.
Source and quote
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'.
Source and quote
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
Source and quote
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
Source and quote
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.
Source and quote
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
- 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)
Source and quote
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)
Source and quote
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
Source and quote
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
Source and quote
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.
Source and quote
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
Source and quote
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'.
- Air ambulance
- covered
- Ground ambulance
- NOT covered (unless state law)
Source and quote
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.
- Report issued
- 2024-08-28 (report document dated March 29, 2024)
- Status
- Currently Inactive
Source and quote
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).
- Enacted
- No
Source and quote
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.
Source and quote
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
Source and quote
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.
- 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
Source and quote
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.
Source and quote
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
- 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)
Source and quote
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.
Source and quote
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
Source and quote
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.
- Per person
- 6,000
- Married both eligible
- 12,000
- Years
- 2025-2028
Source and quote
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
- carryover basis (donor's adjusted basis) when FMV >= donor basis
- Inheritance
- basis generally = FMV at date of death (step-up)
Source and quote
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.
- Single
- $250,000
- Married joint
- $500,000
Source and quote
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 could not confirm
- Penalty divisor: newest readable LDH I-1670 copy (Oct. 2025, archive) shows $7,200/month since 9/1/2024; confirm no 2026 change (Sept. 2026 archive capture returned 403).
- Does LDH file TEFRA liens? Not addressed in the manual sections read (I-1630, I-1670).
- Current CCW Request for Services Registry size (news snippets ~11,800 in 2026) and assisted-living coverage under waivers; OAAS CCW page (July 2026 archive) does not state waitlist status.
- Medigap under-65 requirement in Louisiana statute.
- NEMT booking process.
- Z-700/Z-800/H-1040/I-1660 came from Wayback copies (Feb 2026 snapshots); confirm no mid-2026 revisions directly with LDH.