At a party years ago, another lawyer asked me what an Elder Law attorney does. I explained that, among other things, I helped people qualify for Medicaid to pay for their nursing home care while protecting their house and money for their spouse and children. The lawyer scowled and said, “I don’t agree with that; I don’t think that’s right.” The response puzzled me, especially since this attorney routinely helped wealthy clients avoid paying estate taxes. Why is it okay for the rich to use trusts and gifts to avoid paying taxes but not “right” for middle-class families to use the same tactics to avoid losing their home or life savings due to an end-of-life illness?

Medicaid Planning is the Right Decision for Many Situations

Certainly, there are some people with substantial wealth who can, and should, pay for their own care, and Medicaid planning is not necessary for them. However, for people whose entire life savings would be quickly wiped out by a nursing home stay, or people who face the loss of their family home due to Medicaid estate recovery, or a wife who needs money to live on while her husband is in a nursing home, or parents who want to make sure their disabled child is taken care of after their deaths, Medicaid planning is definitely the “right” decision.

Consider the situation of two people who both work at the same job earning the same income. One of them lives lavishly and spends all of his income traveling, dining in restaurants, and purchasing luxury items, while the other one lives frugally and saves all of his income. When they retire, the saver has accumulated $400,000, while the other has little to no savings. Imagine that both men have a stroke and must enter a nursing home. The one who lived lavishly qualifies for Medicaid to pay for his nursing home, but the one who lived modestly and saved a few hundred thousand must now pay $10,000 per month for the same care in the same nursing home? Is that fair?

The Medicaid laws allow protection of assets

Medicaid planning is a way of leveling the playing field  – it allows people who’ve worked hard and managed to pay off their home or save some money to protect their home and their life savings for their spouse and children.  Just as the rich have the ability to structure their assets in ways to minimize their taxes, the law allows middle-class people to use annuities, gifts, asset-protection trusts, special needs trusts, and other means to protect their home and savings while qualifying for Medicaid.   Elder Law attorneys help clients understand the Medicaid laws and the permissible ways that they can protect their assets under those laws, and there is definitely nothing wrong with that.


Amanda Spence has been practicing Elder Law and assisting clients with Medicaid planning in Raleigh, North Carolina since 1995. If you want to discuss protecting your assets from the catastrophic cost of nursing home care, contact Ms. Spence by telephone at (919) 863-4183 or by email at