Can I gift or transfer assets for less than fair value and receive Medicaid nursing home benefits?

Can I gift or transfer assets for less than fair value and receive Medicaid nursing home benefits?

It depends. Gifts made by the Medicaid applicant and/or spouse within 5 years (60 months) of applying for Medicaid in the nursing home will trigger a transfer penalty period unless an exception to the transfer penalty rules applies. The transfer penalty does not apply to gifts (or transfers for less than fair value) made by the Medicaid applicant and/or spouse to the following:

  • the Medicaid applicant’s spouse;
  • the Medicaid applicant’s child under age 21;
  • the Medicaid applicant’s disabled child or a trust for the sole benefit of the disabled child if the child meets Social Security’s disability criteria;
  • a (d)(4)(A) Medicaid exception trust or (d)(4)(C) pooled trust for the sole benefit of the Medicaid applicant under age 65; or
  • a 529 Uniform Transfers to Minors Act (UTMA) account or other HHSC recognized higher education tuition savings program established before the beneficiary’s 21st birthday by the beneficiary’s parent, stepparent, spouse, grandparent, brother, sister, uncle or aunt, whether related by whole blood, half blood, or adoption.

In addition to the transfer penalty exceptions list above, no transfer penalty will be imposed if title to the Medicaid applicant’s home is transferred for less than fair value to the person’s:

  • sibling provided the sibling has an ownership interest in the home and has resided in the home for at least one year prior to the Medicaid applicant’s institutionalization;
  • child (regardless of age or disability) who resided in the home for at least two years before the Medicaid applicant’s institutionalization and provided care that delayed entry into the nursing home; or
  • to anyone provided the deed is approved by HHSC as an enhanced life estate deed (lady bird deed), and the Medicaid applicant provides a statement of intent to return home.

If none of the above exceptions to the transfer penalty rules does apply, a transfer penalty can still be avoided (or reduced) if:

  • satisfactory evidence shows that the person intended to dispose of the resource at fair market value;
  • satisfactory evidence shows that the resource was transferred exclusively for some reason other than to qualify for Medicaid;
  • imposition of a penalty would result in a undue hardship; or
  • the asset is returned.

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