When one person needs long-term care, the question families ask next is what happens to the one who does not. Here is Part 2 of our conversation, written out – what protects a spouse who stays home, what the five-year look-back really does, whether the state takes the house, and the change coming in 2027.
In this article
Protecting the spouse who stays home
The five-year look-back and transfers
The house, liens, and estate recovery
Having both programs
Separate help with Medicare costs
Immigration status and effective dates
The 2027 retroactive change
Three things to check this week
Protecting the spouse who stays home
This is the scariest one. If my father goes into a nursing home, does my mother end up with nothing?
There are rules that protect the spouse who stays in the community. Some assets and some income can be protected, but the amount depends on the couple’s situation and the rules applied.
What is the federal asset protection figure for the spouse at home?
For 2026 the federal spousal resource standard runs from a minimum of thirty-two thousand five hundred thirty-two dollars to a maximum of one hundred sixty-two thousand six hundred sixty. That is a figure used in a calculation, not money the government hands over.
Why is there both a minimum and a maximum?
Because it is calculated from the couple’s countable assets and the state’s rules. Not every family gets the same amount. Ask Maryland for an assessment before you assume the maximum applies to you.
If the spouse at home has little income, can part of the other spouse’s income be protected too?
Yes. Part of the other spouse’s income can be allocated for living expenses. From July 1, 2026, the base monthly allowance is two thousand seven hundred five dollars. The at-home spouse’s own income counts in that calculation.
Does that monthly allowance go up if housing costs are high?
With allowable excess shelter costs it can rise to the general maximum of four thousand sixty-six dollars and fifty cents. The shelter standard of eight hundred eleven fifty is where the calculation starts, not an extra payment.
Does Medicaid send a separate check to make up the difference?
No. It is a rule that redirects part of the institutionalized spouse’s income to the spouse at home. It is not a new government payment. Ask for the worksheet showing income, shelter costs, and the actual allocation.
How should a couple confirm the protected amount that applies to them?
Get the state’s calculation, and talk to an elder law attorney before you change a title or give money away. That helps you confirm the protections, but no one can promise an amount without looking at your situation.
The five-year look-back and transfers
A neighbor told me if I put my mother’s house in my name now, Medicaid cannot touch it. Is that good advice?
Do not transfer a title on a neighbor’s word. A gift can create a period when Medicaid will not pay for long-term care. There are exceptions, but check your own situation first.
If it is no longer my mother’s property, why does it still affect eligibility?
Because a long-term care review looks at how assets moved during a sixty-month look-back. They look at what was given away or sold for less than it was worth, not only what is left.
What happens with a transfer that does not meet an exception?
There can be a penalty period when long-term care services are not paid for. It does not mean every Medicaid medical benefit stops automatically. You have to find out which services are affected and for how long.
How is that non-payment period calculated?
Broadly, the amount transferred for nothing is divided by the nursing facility cost figure the state uses for this calculation. Confirm the current figure and dates with Maryland. An example cannot set your own period.
Could you walk through a made-up example?
Say ninety thousand dollars was gifted and we assume a divisor of nine thousand a month. That gives ten months. The nine thousand here is an illustration, not Maryland’s confirmed figure.
Does that automatically make the adult children responsible for the bill?
No. The rule is about paying for the applicant’s care. It does not by itself create a family obligation to pay. But it can leave the person short of money for the care they need.
Does the penalty period start on the day of the gift?
It is not simply counted from the gift date. It also depends on things like being otherwise eligible and having an application for that care approved. The caseworker calculates the actual start from the specifics.
Are there exceptions for transferring the house?
Yes. Transfers to a spouse, a child under twenty-one, or a blind or disabled child can qualify for an exception. Do not apply the home transfer exceptions to every kind of gift.
Are there exceptions for a sibling, or an adult child who provided care?
A sibling needs an equity interest and must have lived in the home for at least one year before admission. A caregiver child must have lived there at least two years and met the requirement of keeping the parent out of a facility.
Is living with a parent for two years enough on its own?
No. You also need evidence that the care is what let the parent stay home. Keep care records, and get legal advice before you transfer a title. Do not assume the exception will be approved.
What is the single most important thing to remember about the look-back?
Do not start giving property away to create eligibility. If care is needed now, get advice now. A five-year look-back does not mean every applicant has to wait five years.
The house, liens, and estate recovery
Let us talk about the house directly. Does Medicaid mean you have to sell it?
Not automatically. Depending on who lives there and whether the person intends to return, the home can be excluded from the count. But being excluded for eligibility does not erase every later claim.
Even if the home is excluded, can home equity affect long-term care eligibility?
Yes. For 2026 the federal home equity limit runs between seven hundred fifty-two thousand and one million one hundred thirty thousand dollars. The state sets the limit it applies, and there can be exceptions when a protected family member lives there.
What does home equity mean?
The value of your own share after subtracting secured debt such as a mortgage. It is not necessarily the same as the sale price of the whole house.
What if the applicant’s equity is over the state’s limit?
It can affect long-term care eligibility, but there are exceptions when a spouse or a child meeting the conditions lives there. Check with the eligibility office or an elder law attorney before you sell or transfer.
What does it mean to have a Medicaid lien on the house?
A lien is a legal claim on real property. Maryland can place one in certain circumstances for someone in a facility. It is not placed automatically just because someone received Medicaid.
What conditions matter for a lien tied to facility care?
It applies when a recipient in a facility, contributing income toward the cost of care, is determined to have no reasonable expectation of returning home. Before that determination, Maryland has to give notice and a chance for a hearing.
Can family living in the home prevent that lien?
Yes. A spouse living there or a child who meets the requirements is protected. A sibling with an equity interest who lived there at least a year before admission can also qualify. Confirm the exact conditions.
What does estate recovery after a recipient’s death mean for the family?
Estate recovery is the process of recovering recoverable benefits from what the deceased recipient left behind. It does not mean the state automatically takes the house.
Does Maryland’s estate recovery only apply to people fifty-five and over?
Benefits received after fifty-five are the main recoverable category. But there are separate recovery rules for property with a facility-related lien. Saying it never applies under fifty-five would be inaccurate.
What if a spouse or a protected child is still living?
Recovery is limited when there is a surviving spouse or a protected child. That includes an unmarried child under twenty-one, or a blind or disabled child. Do not read it as a promise that every claim disappears forever.
If a family receives a recovery claim, what do they do first?
Read the notice and the deadline to respond. Request an itemization of the claim and find out whether survivor protections or a hardship exception apply. You can also ask the estate attorney about the order debts are paid in.
If there is a recovery claim, does the house have to be sold?
Not necessarily. Other estate assets can satisfy a valid claim, and protections or hardship may apply. Do not assume the house is automatically lost or automatically safe. Have the actual claim reviewed.
If selling the house would leave a dependent with nowhere to live, is there hardship relief?
Maryland has an exception for cases of serious hardship. The rules describe someone like a dependent who lived in the home at the time of death, had lived there continuously for at least two years before that, and cannot arrange other housing.
Which Medicaid payments can be included in a recovery claim?
Maryland can pursue benefits beyond the nursing home bill. The actual amount depends on what was paid, the legal basis, and the exclusions. Do not assume everything is recoverable. Ask for the itemization.
Are Medicare premiums and cost sharing paid on someone’s behalf excluded from recovery?
Yes. Maryland excludes Medicare premiums, copays, and deductibles paid on your behalf from estate recovery. Keep that separate from whether other Medicaid services are recoverable.
Who should review a lien or an estate recovery notice with us?
Start with the contact on the notice itself and the Medicaid office. For property or estate questions, take the notice to an elder law or estate attorney before the response deadline.
Having both programs
Can someone have Medicare and Medicaid at the same time?
Yes. You can qualify for both. What Medicaid covers varies. Some people get full benefits and some get help only with Medicare costs.
With both, which one pays first for a Medicare-covered service?
Medicare pays before Medicaid for services Medicare covers. Medicaid pays after others that have a payment responsibility. If there is other insurance, review the whole picture together.
After Medicare pays, what can Medicaid help with?
Depending on eligibility, it can help with Medicare costs or with services Medicare does not cover. Long-term care can be included when the conditions are met. Having both does not mean every bill is paid in full.
If Medicaid is approved, should someone drop Medicare?
Do not assume that and cancel. Check with SHIP on how the two work together, and whether your situation calls for a plan change.
Separate help with Medicare costs
If someone does not qualify for full Medicaid, can they still get help with Medicare costs?
Yes. There is help with Medicare costs even without full Medicaid benefits. Each one has to be checked against its own standard.
What programs help with Medicare costs?
Medicare Savings Programs help with premiums, and in some categories with other cost sharing. Extra Help assists with Part D prescription costs. Check the eligibility rules for each.
What is the 2026 Extra Help limit for one person?
For 2026 the published figures for one person are an annual income of twenty-three thousand nine hundred forty dollars and countable resources of eighteen thousand ninety. Note that income there is annual, not monthly.
Who gets Extra Help automatically, and who has to apply?
People with Medicare who have full Medicaid, state help with the Part B premium, or SSI get Extra Help automatically. Everyone else can apply through Social Security.
Where do you apply for a Medicare Savings Program?
Through the state Medicaid program. State standards can be more generous than the general federal ones, so do not give up based on a national chart. Check the standard actually applied.
Immigration status and effective dates
Many of our viewers are immigrants, or their parents are. Does Medicaid apply the same way?
Eligibility based on immigration status has to be checked separately. Medicare and Medicaid have different rules, and for Medicaid both the status and the timing matter.
What should an older immigrant ask Social Security about Medicare?
Ask whether they qualify on age and work credits, and whether a spouse’s record can be used if that applies. Having a green card alone does not settle Medicare eligibility.
What if someone does not qualify for premium-free Part A?
At sixty-five or older, there are cases where you can buy into Part A. For a lawful permanent resident the conditions include five years of continuous residence. Confirm the full eligibility and enrollment rules with Social Security.
How is immigration eligibility different for Medicaid?
Many qualified immigrants face a five-year waiting rule, but you also have to check the exemptions and the status restrictions. Five years having passed does not by itself guarantee benefits.
Are there exceptions to that waiting rule?
Yes. Maryland makes exceptions for eligible children and pregnant people, among others. Different categories can apply even within one family, so check your own exact category.
What changes in October 2026?
From October 1, federal Medicaid immigration eligibility narrows. Maryland says some refugees and people granted asylum may lose coverage unless they fit another qualified status or exception. Read the state’s notice right away.
Where do immigrant families check their own Medicaid eligibility?
For Maryland Medicaid immigration eligibility, contact Maryland Health Connection or the agency on your notice. SHIP helps with Medicare counseling, but it does not decide Medicaid immigration eligibility.
The 2027 retroactive change
What is changing about coverage for bills from before you apply?
There is retroactive coverage for eligible services received before the month you applied. For applications filed on or after January 1, 2027, the federal retroactive period gets shorter.
How does that change for older applicants?
For older adults it generally goes from up to three months before the application month to two. The adult expansion group is treated differently, at one month. You still have to meet eligibility in each retroactive month.
Three things to check this week
Can you give us three things a family can do this week?
Ask about the support that fits the care needed now, review any planned transfer of property, and organize the financial records. That is what lets the agency give you an answer that fits.
Who do you call first about care support?
Call Maryland Access Point at eight four four, six two seven, five four six five. Describe the care needed and ask what is available now and whether it is time to look at the Community Options registry.
What should you do before gifting money or changing a title?
Before you sign, have an elder law attorney review the transfer plan and what it does to Medicaid. That does not mean stopping ordinary living expenses or spending on your own care.
Which financial records should a family gather?
Five years of bank statements and a record of gifts and transfers. Write down the date, the amount, who received it, and why. Records help the review, but records alone do not remove a penalty.
Where can someone get free Medicare counseling?
Call the Maryland Department of Aging at one, eight hundred, two four three, three four two five and ask for a SHIP counselor. In another state, find your local SHIP at shiphelp dot org.
Who do you ask about the legal side of the house and long-term care planning?
Review property decisions with an elder law attorney. For Maryland long-term care program questions, call four one zero, seven six seven, one seven three nine. Lining up legal advice should not delay an urgent eligibility question.
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