5 Signs That It's Time to Talk About Medicaid

Watching a parent or loved one age can be both beautiful and challenging. One day they're independent and thriving, and the next, you're noticing small changes that hint at bigger conversations ahead. If you're an Ohio family wondering whether it's time to think about Medicaid planning, you're not alone: and you're definitely not too early to start asking these questions.

The truth is, most families wait until there's a crisis to think about long-term care planning. But by then, many of the best strategies for protecting assets and ensuring quality care are no longer available. Here are five key signs that it might be time to start having those important conversations and taking action.

1. Your Parent Is Over 65 and Doesn't Have Long-Term Care Insurance

If your parent or relative has reached their mid-60s without long-term care insurance, it's time to start thinking seriously about Medicaid planning. Here's why this matters so much: the average cost of a nursing home in Ohio ranges from $8,000 to $12,000 per month, and that's only going up.

Without long-term care insurance, families often face an impossible choice: either pay these crushing costs out of pocket (which can quickly drain a lifetime of savings) or spend down assets to qualify for Medicaid. But there's a third option that many families don't know about: proactive Medicaid planning that legally protects assets while ensuring your loved one gets the care they need.

The key here is that once someone needs care immediately, many protective strategies are no longer available. Insurance companies also become much more selective (and expensive) as health issues develop. If your parent is still relatively healthy but approaching their late 60s or 70s, now is the time to explore your options.

2. You're Already Caring for a Parent Whose Health Is Declining

Are you finding yourself doing more and more for your parent or spouse? Maybe you're helping with medications, driving them to doctor appointments, or you've noticed they're having trouble with tasks that used to be routine. These changes: whether physical, cognitive, or both: are often the first signs that more intensive care might be needed down the road.

This is actually one of the most important times to start Medicaid planning because you're already seeing the trajectory. You have a sense of where things are headed, but you still have time to make strategic decisions.

Many families in this situation feel guilty about planning for Medicaid: like they're somehow giving up on their loved one or planning for the worst. But it's actually the opposite. Thoughtful planning means you'll be able to focus on care and quality time together, rather than scrambling to figure out finances during a crisis.

Cognitive changes deserve special attention here. If you're noticing memory issues, confusion with familiar tasks, or personality changes, these could be early signs of dementia. The earlier you start planning, the more likely your parent can still participate in important decisions about their own care and finances.

3. Your Family's Net Worth Is Under $1 Million

This might sound like a lot of money, but when it comes to long-term care costs, it's really not. A family with $500,000 in assets might feel financially secure, but two years in a nursing home could completely wipe out those savings.

In Ohio, to qualify for Medicaid nursing home benefits, a single person can only have $2,000 in countable assets. For married couples, the rules are more complex, but the healthy spouse (called the "community spouse") can typically keep about half the couple's assets, up to around $157,920 in 2025.

If your family's total assets fall somewhere between these Medicaid limits and about $1 million, you're in what planners call the "Medicaid planning sweet spot." You have enough assets that losing them would significantly impact your family's financial security, but not so much that you can easily afford to pay for long-term care indefinitely.

For families in this range, strategies like asset protection trusts, strategic gifting, annuities and other planning tools can make a huge difference. But these strategies take time to implement effectively.

4. A Major Health Event Just Happened

Sometimes the wake-up call comes suddenly. Your parent has a stroke, a bad fall, a heart attack, or another serious health event that lands them in the hospital. If they need rehabilitation or can't safely return home alone, this is often when families first encounter the reality of long-term care costs.

If this describes your situation right now, don't panic, but do act quickly. Even in crisis situations, there are many strategies available, though your options may be more limited than if you'd planned ahead.

After a major health event, focus on these immediate priorities:

• Get your loved one the medical care they need
• Consult with an elder law attorney before making major financial decisions
• Don't transfer assets or make large purchases without professional guidance
• Keep detailed records of all medical and care expenses

The period right after a hospitalization often involves skilled nursing or rehabilitation services that may be covered by Medicare. This can provide some breathing room to explore Medicaid planning options, but don't wait: Medicare's skilled nursing coverage is limited and has strict requirements.

5. You Still Have Five or More Years Before Care Is Likely Needed

Here's the counterintuitive one: if your parent is still healthy and active, but you're thinking ahead to potential future needs, you're actually in the best possible position for Medicaid planning. This is when you have the most options and the most time to implement strategies that could save your family hundreds of thousands of dollars.

Why five years? Because of Medicaid's "look-back period." When someone applies for Medicaid benefits, the program looks back five years at all financial transactions to make sure assets weren't transferred simply to qualify for benefits. Any transfers made within this five-year window can result in penalties and delays in benefits.

But transfers made more than five years before applying? Those are generally not counted at all. This means that if you start planning early enough, you can legally move assets to protect them while still ensuring your loved one will qualify for Medicaid when they need it.

Early planning also allows you to:

• Set up irrevocable trusts that remove assets from Medicaid consideration, and from Ohio's Medicaid Estate Recovery program
• Make strategic gifts to family members
• Purchase exempt assets like a home or car
• Explore long-term care insurance options while your parent is still healthy
• Have important conversations while your loved one can fully participate in decisions

Why Ohio Families Need to Start Planning Now

Ohio's Medicaid rules have some unique features that make early planning especially important. The state has been relatively generous with its Medicaid program, but like many states, it's facing budget pressures that could lead to tighter restrictions in the future.

Ohio also participates in Medicaid waiver programs that can help people receive care at home or in community settings rather than nursing homes. These programs often have waiting lists, and getting on those lists early can make a big difference in your loved one's quality of life.

The state's asset limits are also quite strict. While some assets (like a primary residence and one car) are generally exempt, most savings, investments, and other property count toward the $2,000 limit for single applicants. For families with even modest savings, this means careful planning is essential.

Taking the Next Steps

If any of these signs sound familiar, don't let worry or overwhelm stop you from taking action. Medicaid planning isn't about gaming the system: it's about understanding the rules and making smart, legal decisions that protect your family's financial security while ensuring your loved one gets good care.

Start by having an honest conversation with your parent or relative about their wishes for future care. Many people have strong preferences about where they'd like to live if they need help, and understanding these preferences can guide your planning decisions.

Then, consider consulting with an elder law attorney who specializes in Medicaid planning. Every family's situation is unique, and strategies that work well for one family might not be appropriate for another.

Remember, this isn't just about money: it's about preserving dignity, maintaining family relationships, and ensuring that your loved one can age with grace and security. It's also about honoring the wishes of parents to leave a legacy to their children, instead of to a nursing home. The families who start planning early consistently tell us they're grateful they did, not just for the financial protection, but for the peace of mind that comes with being prepared.

The conversation might feel awkward at first, but most parents appreciate knowing that their children are thinking ahead and want to make sure they're protected. After all, they spent years planning and preparing to take care of you. Now it's your turn to plan ahead for them.