CELA cheat sheet

Medicaid long-term care eligibility for a single applicant generally caps countable resources at $2,000; for a married couple the community spouse resource allowance (CSRA) ranges from a floor of about $31,584 to a ceiling of about $157,920 (2024 figures, indexed annually).

Countable resources exclude the home if the institutionalized spouse intends to return or a spouse or certain dependents live there; home equity above the statutory limit (about $1,071,000 in 2024) counts as a resource.

The community spouse may keep a monthly maintenance needs allowance (MMNA) up to a ceiling (about $3,948/month in 2024); excess income of the institutionalized spouse can be diverted to the community spouse through a spousal diversion order or fair hearing.

The 5-year look-back period measures transfers for less than fair market value; penalties are calculated by dividing the uncompensated transfer amount by the state's average private-pay nursing home daily rate.

Penalty periods begin the later of the first day of the month of institutionalization or the date the transfer occurred; partial-month penalties round down and the remainder is disregarded.

Medicaid estate recovery may reach probate assets and, in some states, expanded assets such as joint accounts and life estates; recovery is barred during a surviving spouse's lifetime and while certain heirs reside in the home.

A valid durable power of attorney with gifting authority is required before an agent may make uncompensated transfers; absent express gifting language, self-dealing transfers are voidable and may create Medicaid penalties.

Testamentary intent controls will interpretation; a will requires testamentary capacity, proper execution with witnesses or notarization per state law, and survives challenge only if free of undue influence or fraud.

Social Security and SSI benefits are not assignable or transferable; representative payees manage benefits for incapacitated beneficiaries but cannot convert funds to their own use.

A first-party special needs trust (SNT) holds the beneficiary's own assets (inheritance, personal injury award, back benefits) and must be established before age 65 by the beneficiary, a parent, grandparent, legal guardian, or court.

A third-party SNT holds assets never owned by the beneficiary; it has no age or payback requirement and can be funded by parents or grandparents through wills, life insurance, or outright gifts.

First-party SNTs must include a Medicaid payback clause; on the beneficiary's death, remaining assets reimburse the state for Medicaid benefits paid, then pass as directed.

Pooled trusts are managed by nonprofit associations and may hold first-party funds for beneficiaries of any age; a separate account is maintained for each beneficiary and payback applies to the beneficiary's account.

An ABLE account permits up to $18,000 (2024) in annual contributions; funds are excluded from SSI resource counting up to $100,000, and distributions must be for qualified disability expenses.

SSI countable resources for an individual are capped at $2,000 ($3,000 for a couple); an SNT is excluded if the beneficiary has no legal right to compel distributions and the trust meets the sole-benefit standard.

In-kind support and maintenance (ISM) reduces SSI benefits; the presumed maximum value (PMV) reduction is one-third of the federal benefit rate plus $20, applied when food and shelter are provided.

Distributions from an SNT for food or shelter may count as in-kind income and reduce SSI; cash distributions to the beneficiary are countable income in the month received and a resource the following month.

Supplemental needs trusts must prohibit the trustee from distributing funds in a way that supplants benefits the beneficiary would otherwise receive from public programs.