As an attorney who specializes in elder law, estate planning and Medicaid planning, clients frequently ask me, “Does Medicaid take your house when you go into a nursing home?”

Medicaid is a complex program with overarching federal policies and unique state-level regulations. When it comes to Medicaid coverage for long-term care services and supports, there are several eligibility guidelines that apply specifically to seniors’ homes before the application process, during nursing home residency and after their death.

Long-Term Care Medicaid Guidelines for Homeowners

The basic rule is that a person's primary residence is an exempt asset and therefore will not be counted when they apply for Medicaid. However, when a senior specifically applies for Medicaid coverage of long-term care services, including nursing home care, their equity interest in their home must fall below a certain amount set by their state to be considered exempt. Equity interest is the Medicaid applicant’s interest in the equity value of the home (fair market value (FMV) minus any debts secured by the home).

In 2022, the minimum home equity limit is $636,000, but states (typically those with high property values) can choose to raise this limit up to the maximum of $955,000. (California is the only state without a Medicaid home equity limit.)

There are other instances where a Medicaid applicant’s primary residence may be exempt regardless of value. You can read more about these conditions and requirements in this article: When Is a Primary Residence Exempt From Medicaid? In most states, a primary residence that is deemed exempt will continue to be considered as such for the duration of the Medicaid recipient’s lifetime.

Medicaid Estate Recovery and Home Ownership

Medicaid isn’t in the business of “taking” seniors’ homes while they are alive. However, upon the death of a Medicaid recipient, the state may seek repayment of its outlays for the senior’s long-term care. This has become increasingly common as more seniors require long-term care but do not have the personal funds to pay for it.

The Medicaid Estate Recovery Program (MERP) recoups this money by filing claims against any assets a Medicaid recipient held an interest in at the time of their death, such as their home. However, if a senior died without any assets (or with very few assets), then there is no way for the state to be repaid.

As a very basic example, say Mom was in a Medicaid-certified nursing home for two years and the state paid the facility $4,000 each month for her care. Once Mom passes away, MERP will file a claim against her estate in the amount of $96,000 ($4,000 x 24 months). If Mom’s house was still in her name at the time of her death, then it will have to be sold to repay the state the $96,000. Any proceeds exceeding the $96,000 can then be distributed in accordance with Mom's will (or the state’s intestate succession laws).

Each state handles MERP a little differently, and cases are often determined on an individual basis because they are so unique. I strongly advise families who are trying to achieve or maintain Medicaid eligibility for an aging loved one to seek out a reputable attorney with plenty of experience in Medicaid and estate planning strategies. Unless a senior has very low income and no assets, legal assistance is necessary to ensure all steps have been taken and prevent any surprises down the road.

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Read: Medicaid Estate Recovery: Long-Term Care Benefits Aren’t Necessarily “Free”

In summary, the general rule is that, while a senior is alive, their home will not be “taken” or required to be sold to pay the nursing home or the state government. However, their home may need to be sold to repay the state after their death.