Is It Too Late for Medicaid Planning If Care Has Already Started?

Families often assume that Medicaid planning must be completed before a loved one enters a nursing home. But the reality is more hopeful: it’s not too late to start planning—even after care has already begun. If your loved one is already in a nursing home and you’re starting to worry about the mounting costs, take a breath. Medicaid planning can still make a meaningful difference, and solutions like a Medicaid Compliant Annuity (MCA) may still be available. Let’s explore your options. 

Understanding When Medicaid Planning Can Begin

To qualify for long-term care Medicaid, applicants must meet strict income and asset requirements. While the ideal time to begin planning is just before or upon entering a nursing home, many families don’t realize the full financial impact until they’ve already received a few monthly bills. That’s okay.

In fact, many people begin Medicaid planning after the care has started. This is often when a spouse or adult child steps in and starts asking questions—usually after seeing that first monthly invoice.

The good news? It’s not too late.

Read more: Can You Keep the Family Home and Still Qualify for Medicaid? 

Medicaid Planning Tools That Work After Care Begins

If your loved one is already receiving care, several Medicaid planning strategies may still be effective, including:

Medicaid Compliant Annuities (MCAs)

MCAs are especially useful for married couples. They allow a healthy spouse to convert excess countable assets into an income stream, preserving financial stability and helping the ill spouse qualify for Medicaid faster.

These annuities must meet specific requirements to be compliant—such as being irrevocable, non-transferable, and naming the state as the beneficiary.

Spousal Transfers and Protections

Medicaid permits certain asset transfers between spouses without penalty. That means the healthy spouse (also called the “community spouse”) can retain more assets without affecting eligibility. This includes transfers of income and sometimes even the family home.

Each state enforces a Community Spouse Resource Allowance (CSRA), which allows the healthy spouse to keep a portion of assets (the exact number varies by state). Additionally, the community spouse is entitled to a Monthly Maintenance Needs Allowance (MMNA) to ensure they have enough income to maintain their standard of living, even if that income is transferred to them from the spouse receiving care.

Spend-Down Strategies

For single individuals or those without spousal planning options, certain purchases may help you “spend down” to the amount needed to qualify for Medicaid, such as:

• Paying off debts or medical bills
  
• Prepaying funeral and burial expenses
  
• Purchasing exempt assets (e.g., a car or home repairs)

Read more: Medicare vs. Medicaid: Paying for Long-Term Care

Don’t Delay—Planning Still Matters

While Medicaid planning is best done early, it’s never too late to act if you or your loved one has recently entered a skilled nursing facility. Every month of delay can mean thousands of dollars lost to private-pay costs that could have been avoided.

A trusted professional can help you understand your specific situation, create a Medicaid strategy, and even expedite the application process if needed. 

Take the Next Step

If you’re overwhelmed by care costs and wondering if Medicaid planning can still help, the answer is almost always yes. Tell us about your situation, and we’ll help you understand the best options available—before another month’s bill arrives.