Practice Area · Elder Law & Medicaid Planning
Protect a lifetime
of savings from the
cost of long-term care.
A will decides what happens after death. The years of paid care that can come before it are a separate risk — and the one most plans never address. Medicaid and long-term-care planning by a licensed Texas attorney with 30+ years in practice, coordinated with a specialized Medicaid consulting partner so the legal protection and the application move as one.
The risk most plans never address.
Most families plan for death and skip the years before it. A will, a trust, and powers of attorney are built to move assets and authority after someone is gone. They say almost nothing about the long stretch of paid care — assisted living, skilled nursing, memory care — that can run for years and consume an estate while its owner is still alive. The cost of that care, not the cost of dying, is what most often empties an account that took a lifetime to build.
Medicaid is the program that pays for long-term care when private funds run out. Qualifying for it is not a matter of being poor; it is a matter of legal structure. The rules reward planning and penalize improvisation, and the difference between the two is frequently measured in tens or hundreds of thousands of dollars. The work on this page is the legal planning that preserves what can lawfully be preserved — and, where the need has already arrived, the planning that still protects what remains.
Where a life’s savings is lost.
Each of the following is a place families lose money they did not have to lose. Naming them is the point: a referring CPA or estate attorney will recognize every one.
The five-year look-back
When you apply for long-term-care Medicaid, the program reviews asset transfers made in the sixty months before the application. Gifts and below-market transfers inside that window create a penalty period — a stretch of ineligibility calculated from the amount transferred. This is why a well-meant gift to a grandchild, or signing the house over to a child, can backfire when made too close to a need for care. It is also why the single most valuable input to this work is time. The earlier the planning, the wider the options.
Protecting the healthy spouse
When one spouse needs care and the other remains at home, federal law does not require the couple to spend everything before either qualifies. The spouse who stays home — the community spouse — is allowed to keep a protected share of the couple’s combined resources and a protected level of monthly income. Used correctly, these spousal protections keep the well spouse from being impoverished by the other’s care. Used carelessly, or not at all, they are simply left on the table.
The home
A Texas homestead is generally exempt while the owner or a spouse lives in it — which leads many families to assume the house is safe. It is safe during life. After death, it can be exposed to the Medicaid Estate Recovery Program, through which the state seeks reimbursement from the estate for the care it paid for. The exposure is real and routinely missed, because it surfaces only after the planning window has closed. Addressing it is part of the work, not an afterthought to it.
The revocable-trust trap
A revocable living trust is an excellent estate-planning tool: it avoids probate, manages incapacity, and keeps distributions private. But because you keep control of a revocable trust, its assets remain fully countable for Medicaid. A trust that is perfect for the estate plan can defeat Medicaid eligibility without anyone seeing it happen — the same document, working exactly as designed, producing the opposite result. Estate planning and Medicaid planning pull on different levers, and a plan built for one is rarely the plan that protects the other.
Spend-down is not the only path
The common belief is that a family must exhaust its savings before Medicaid will pay — that the only route to qualification is to write checks until nothing is left. That is not the law. Between an untouched estate and a depleted one sits a body of legal strategy: the proper use of exempt assets, permitted transfers, spousal protections, and, in the right circumstances, specific irrevocable structures. A spend-down consumes what legal planning would have preserved.
Crisis planning versus early planning
There are protections available even when the crisis is already here — when a parent is in the hospital and the nursing-home bill has already started. The menu is narrower than it would have been, but it is not empty, and the worst outcome is the family that assumes nothing can be done and so does nothing. The widest set of options belongs to those who plan before the look-back clock begins. Either way, there is almost always more that can be done than a family is first told.
One coordinated solution, not three vendors.
This work is rarely the whole of a family’s relationship with its advisors. There is usually already a CPA who knows the numbers and an attorney who drafted the estate plan. The role here is co-counsel and consultant, not competitor. For the professional who refers a client, the message is plain.
Keep your client. Bring in counsel for the Medicaid and long-term-care piece. You stay primary — the family gets one coordinated plan instead of three vendors who have never spoken to one another.
The legal planning is only half of what a family in this situation needs. The other half is specialized Medicaid consulting: the application itself — the filing, the documentation, the follow-through to approval. This practice coordinates that work with Medicaid Filing Connection, the firm led by Dr. Amy Arp, MSW, author of Senior Transitions 101. The relationship is established and two-way, and the division of labor is clean: Lozano Legal Advisors handles the legal planning and asset protection; the specialized Medicaid consulting is provided by Medicaid Filing Connection, which carries the application from filing through to approval.
Around a single case, that team brings estate planners, Medicaid specialists, insurance and family-support professionals, and realtors — the full set of hands a long-term-care transition actually requires. The result is what families almost never get on their own: legal planning and specialized Medicaid consulting assembled into one coordinated unit, with a single point of contact, rather than a handful of vendors introduced to each other for the first time after the emergency has already begun.
Frequently asked questions.
Do we have to spend down everything before Medicaid will pay?
No. This is the single most costly misunderstanding in long-term-care planning. The law permits the use of exempt assets, certain transfers, spousal protections, and specific irrevocable structures to preserve resources that an uninformed spend-down would simply consume. How much can be protected depends on the facts — marital status, the assets involved, and how early the planning begins — but the choice is rarely all-or-nothing.
What is the five-year look-back?
When you apply for long-term-care Medicaid, the program examines asset transfers made in the sixty months before the application. Gifts or below-market transfers in that window create a penalty period of ineligibility. The look-back is the reason planning done early is worth so much more than planning done late, and the reason transfers should never be made informally without understanding their effect on eligibility.
Will the State take our home?
A Texas homestead is generally exempt while the owner or a spouse lives in it. The exposure comes later: after death, the home can be reached through the Medicaid Estate Recovery Program, which seeks reimbursement from the estate for the care Medicaid paid. Whether and how that exposure can be addressed depends on the planning done beforehand, which is precisely why the home is part of the conversation from the start.
Can’t I just transfer my assets to my children?
Transferring assets to children is one of the most common ways families create the problem they were trying to avoid. A transfer made inside the five-year look-back triggers a penalty period; a transfer made for the wrong reasons can carry tax and creditor consequences of its own. There are circumstances where transfers are appropriate — but they are a planning decision made with counsel, not a do-it-yourself fix.
Is it too late if a parent is already in a nursing home?
Usually not. Crisis planning — planning done after care has already begun — has fewer options than early planning, but it is rarely empty. The mistake is assuming that because the emergency has arrived, nothing can be done, and then watching savings deplete that could have been protected. The first step is a consultation to see what the facts allow.
How does this work with my CPA or my estate attorney?
It works alongside them. This practice serves as co-counsel and consultant on the Medicaid and long-term-care piece; your existing advisors stay primary on everything else. The legal planning is handled here, the specialized Medicaid consulting is provided by Medicaid Filing Connection, and the family deals with one coordinated effort rather than several disconnected ones.
