Book a consultation
Send us a message
finger pointing to a graph showing cost rising

The potential high cost of using irrevocable trusts for Medicaid planning

by Legacy plan
February 26, 2024

Medicaid planning is a vital component of preparing for potential long-term care needs, especially as individuals advance in age. This planning often involves strategic financial maneuvers to safeguard one's assets, particularly for those who might require Medicaid assistance in the future. A prominent strategy in this realm is the utilization of irrevocable trusts. Predominantly, these trusts are used to protect significant assets, such as a homeowner's primary residence, from being subject to Medicaid estate recovery after the homeowner's death.

This strategic move is primarily aimed at preserving the value of the home for future generations, ensuring that the asset isn’t claimed to recoup the costs of long-term care covered by Medicaid. This article seeks to delve deep into the nuances of using irrevocable trusts as a means of Medicaid planning. It aims to unravel the complexities, benefits and potential drawbacks of this approach, with particular emphasis on how it impacts the preservation of home values.

Understanding irrevocable trusts

lawyer explaining irrevocable trust

An irrevocable trust represents a firm legal arrangement in which an individual, referred to as the grantor, transfers ownership of certain assets – most commonly a home – into a trust. This action effectively removes the assets from the grantor’s direct control and estate. Once this transfer is complete, the assets, now under the trust’s name, are no longer considered part of the individual's personal estate for the purpose of Medicaid eligibility and estate recovery.

The nature of an irrevocable trust is such that, upon its creation and the transfer of assets into it, the grantor relinquishes any control over these assets. This means that decisions regarding the trust and its assets can no longer be unilaterally made by the grantor. Any alterations or revocations of the trust can only be executed with the explicit consent of the beneficiaries, who are often family members.

This irreversible transfer serves a dual purpose. First, it helps to ensure that the assets, particularly the home, are not accounted for in the estate value when Medicaid assesses eligibility for long-term care benefits. Second, it safeguards the home from being claimed by Medicaid estate recovery processes after the grantor’s death. Medicaid estate recovery is a legal process through which the state seeks to recoup the costs of long-term care benefits paid out to an individual, potentially claiming against assets like a home that remain in the deceased's estate.

However, the implications of establishing an irrevocable trust extend beyond these benefits. Homeowners must consider the legal and financial ramifications, including tax implications, potential loss of property tax exemptions and the impact on their overall estate planning strategy. The decision to place a home into an irrevocable trust is a significant one, requiring thorough understanding and careful consideration of both the immediate and long-term financial landscape of the individual and their beneficiaries.

Medicaid estate recovery explained

Medicaid estate recovery is a crucial concept for those engaged in long-term care planning. This process is initiated by the state to recover the costs incurred from Medicaid benefits provided to an individual, particularly for long-term care and related expenses, after their death. The target of this recovery effort is the deceased individual’s estate, which often includes significant assets like their home.

Booklet opening animation of our free requestable booklet 'What is Estate Planning'

When an individual's home is transferred into an irrevocable trust, it effectively becomes the property of the trust and is no longer part of the individual’s personal estate. This strategic transfer plays a pivotal role in Medicaid planning, as it essentially shields the home from being subject to estate recovery. As a result, the value of the home is preserved for the beneficiaries of the trust, rather than being used to reimburse Medicaid expenses.

However, the decision to utilize an irrevocable trust for this purpose is not without its tradeoffs. The most immediate impact is the loss of direct control over the asset. Once the home is transferred into the trust, the original owner can no longer make unilateral decisions about the property. Additionally, there are other potential financial implications to consider. These may include tax consequences and the loss of certain homeowner benefits, such as property tax exemptions, which can be substantial depending on the jurisdiction.

Therefore, while protecting the home from Medicaid estate recovery can represent significant financial savings for the estate, it's essential to balance this benefit against the immediate and long-term implications of losing control over the asset. Homeowners must carefully evaluate their situation, considering factors such as their likelihood of requiring long-term Medicaid-funded care, the value of their home and the impact of losing homeowner benefits, before deciding to transfer their property into an irrevocable trust. This evaluation often requires a nuanced understanding of both Medicaid regulations and estate planning principles, highlighting the importance of seeking professional legal and financial advice in these matters.

Loss of property tax exemptions

Transferring a home into an irrevocable trust for Medicaid planning purposes comes with notable tax implications, particularly concerning property tax exemptions. Homeowners typically benefit from various exemptions that significantly lower their property tax bills. These exemptions can include reductions for primary residence status, senior citizen discounts, disability exemptions and homestead provisions, among others. However, once a home is placed into an irrevocable trust, the ownership of the property shifts from the individual to the trust. This change in ownership status can lead to the forfeiture of these valuable exemptions.

The impact of losing property tax exemptions is not trivial and can result in a marked increase in annual property taxes. This can be particularly burdensome for retirees or those on a fixed income who initially benefitted from reduced taxes due to their personal circumstances. The higher tax liability imposed on the property held within the trust can accumulate over the years, potentially amounting to a significant financial cost.

hand holding model home in hand

For instance, in some states, homeowners may be eligible for substantial homestead exemptions that reduce the taxable value of their home by a fixed amount or percentage, leading to lower property tax bills. When the home is transferred to an irrevocable trust, these exemptions may no longer apply, as the trust does not qualify for the same exemptions that an individual homeowner does. As a result, the property's taxable value increases, leading to a higher property tax bill.

It's crucial for homeowners considering this Medicaid planning strategy to thoroughly evaluate the financial tradeoffs. While protecting the home from Medicaid estate recovery can be a significant advantage, the potential increase in property tax liability can offset some of these benefits. The decision should involve a careful analysis of the homeowner's current and future tax situation, the value of the property tax exemptions they are currently receiving and the estimated increase in property taxes if these exemptions are lost.

It’s crucial to assess the likelihood of requiring long-term care and consequently needing Medicaid assistance. Not everyone will require such care, and transferring assets to an irrevocable trust may be an unnecessary financial step. Individuals must evaluate their health, family history and other factors to make an informed decision.

Cost comparison: estate recovery vs. tax exemptions

When deciding to use an irrevocable trust for Medicaid planning, homeowners must conduct a careful cost comparison between the potential risks of Medicaid estate recovery and the certain loss of property tax exemptions. This financial decision is complex and varies significantly based on individual circumstances, requiring an in-depth financial analysis.

The risk of Medicaid estate recovery involves the state reclaiming the costs of long-term care from a deceased individual's estate, often targeting the home as a primary asset. The likelihood and duration of requiring Medicaid-funded long-term care significantly influence the potential recovery amount. Additionally, the home's value and the specific Medicaid recovery policies of the state are crucial factors. In cases where extended nursing facility stays are needed, the recovery amount could represent a significant portion of the home's value.

On the other hand, the loss of property tax exemptions is a definite and immediate consequence of transferring a home into an irrevocable trust. This translates into higher annual property taxes, which can accumulate significantly over the years. The extent of this cost depends on the home’s assessed value and the specific tax exemptions the homeowner was eligible for. In regions with high property values and substantial tax exemptions, the increased tax burden can be especially pronounced.

Analyzing the financial impact requires homeowners to consider several factors, including the estimated value of lost tax exemptions over time versus the potential Medicaid recovery amount. Age, health condition, family medical history and the likelihood of needing long-term care are all important considerations. Additionally, expected increases in property value and possible changes in tax legislation may influence the decision-making process.

Exploring alternative Medicaid planning strategies

coins stacked with chess pieces on top

Exploring alternative Medicaid planning strategies beyond irrevocable trusts is crucial for those preparing for potential long-term care needs. , for instance, are an effective tool in this regard. By converting a lump sum into an income stream, they help meet Medicaid's income and asset limits, effectively turning countable assets into non-countable income. However, the structure of these annuities must comply with Medicaid’s stringent rules to avoid disqualification, and their inflexibility can be a limitation.

Long-term care insurance offers another viable option, providing coverage for care costs that Medicaid would typically cover. This type of insurance enables individuals to protect their assets while allowing more choice in care types. The main drawbacks here are the potentially expensive and escalating insurance premiums and the risk that the policy may not cover all care costs. Careful consideration of coverage limits and premium costs is therefore essential when evaluating long-term care insurance.

Additionally, there are various legal strategies that can be employed for Medicaid planning. These include caregiver agreements, life estate deeds, and spend-down strategies, where individuals legally reduce their countable assets. Each strategy has its requirements and potential implications, such as tax considerations, and must be carefully planned to ensure compliance with Medicaid rules.

Given the complexity of Medicaid rules and the diversity of planning strategies, individuals should consider factors like age, health, family dynamics and overall financial situation. It’s vital to understand each option's potential impact on Medicaid eligibility, tax implications and personal financial goals.


In conclusion, Medicaid planning is an integral part of preparing for the future, especially when it comes to long-term care. Among the strategies employed, irrevocable trusts have gained prominence for their ability to safeguard assets like a home from Medicaid estate recovery. However, this strategy comes with significant considerations, notably the relinquishment of control over the asset and potential financial implications, such as the loss of property tax exemptions.

A key aspect of Medicaid planning involves a careful analysis of the individual's likelihood of requiring long-term care. This evaluation helps in determining whether transferring assets to an irrevocable trust is a necessary step. The decision becomes a delicate balancing act between the potential risk of estate recovery by Medicaid and the definite and immediate financial implications, like increased property tax liability.

While irrevocable trusts offer a way to protect one's home value from Medicaid estate recovery, alternative Medicaid planning options are also worth considering. Annuities, long-term care insurance and various legal strategies each have their unique benefits and limitations. These alternatives can sometimes offer a more favorable balance between preserving assets and maintaining flexibility and control.

As with any financial planning, the approach to Medicaid planning should be personalized, taking into account individual circumstances, health status and financial goals. By carefully weighing the costs and benefits of each option, individuals can better prepare for their future care needs while preserving their financial legacy.

How do I create an estate plan?

There are numerous options and scenarios to consider when developing an estate plan that protects your legacy and achieves your objectives, and important decisions should be made with the advice of qualified lawyers and financial experts. Membership with Legacy Assurance Plan provides members with valuable resources and guidance to develop comprehensive estate plans that take life's contingencies into consideration and leave a positive impact for generations to come. Legacy Assurance Plan members also receive peace of mind that a team of trusted, experienced professionals will assist them in developing legal, financial and tax strategies that will meet their needs today and for years to come through periodic reviews.

This article is published by Legacy Assurance Plan and is intended for general informational purposes only. Some information may not apply to your situation. It does not, nor is it intended, to constitute legal advice. You should consult with an attorney regarding any specific questions about probate, living probate or other estate planning matters. Legacy Assurance Plan is an estate planning services company and is not a lawyer or law firm and is not engaged in the practice of law. For more information about this and other estate planning matters visit our website at

Phone - 844.445.3422
Email -
25 common estate planning mistakes booklet

Don't make estate planning mistakes. Avoid common mistakes with our free guide,
"25 Common Estate Planning Mistakes"

Legacy Assurance Plan Shield Logo
Subscribe to Our Monthly Newsletter!

We won't share your email, and we make it easy to unsubscribe!