You’ve seen the headlines: sweeping changes to Medicaid, funding cuts, and new work requirements. But what most media coverage misses is this—long-term care Medicaid isn’t being gutted. The core services for seniors and people with disabilities remain intact. What’s changing is how you qualify, how your assets are treated, and what happens after you’re gone.
If you’re hoping to age in place or planning ahead for assisted living or nursing home care, these changes matter. And the best way to protect what you’ve built is to plan for long-term care the way you plan for everything else—with proactive, coordinated guidance.
At Alperin Law & Wealth, we help families understand what’s really at stake—and how to prepare. Our integrated approach brings legal, tax, and wealth strategies under one roof, so your long-term care plan doesn’t rely on guesswork or last-minute crisis management. Whether you’re planning for your own future or helping aging parents, we equip you with the tools to preserve assets, qualify for care, and maintain peace of mind every step of the way.
Does Trump’s New Law Cut Long-Term Care Medicaid?
No. The new law—called the OBBBA—does not eliminate coverage for nursing homes, assisted living, or in-home care under long-term care Medicaid. But that doesn’t mean nothing is changing.
Here’s what’s staying the same:
- Core benefits remain intact. Medicaid will still cover institutional care, personal care services, and home-based supports under HCBS waivers.
- Eligibility planning is still possible. Legal tools like asset protection trusts remain valid strategies for qualifying for care.
Here’s what’s tightening:
- Home equity cap standardization. A new federal cap goes into effect in 2028.
- Shorter retroactive coverage. The window to get reimbursed for care received before applying is shrinking.
- Stricter documentation requirements. States will more closely verify citizenship and lawful status.
- Administrative burdens may rise. Work requirements and budget neutrality provisions could discourage states from innovating or expanding services.
For now, the Medicaid safety net is still here—but the rope may be thinner. Medicaid planning isn’t optional anymore. It’s essential.
What’s Changing About the Medicaid Home Equity Cap?
The most significant change is a national cap on home equity: $1 million, starting January 1, 2028. Until now, states had the flexibility to set caps within a federal range ($713,000 to $1,071,000 in 2025, adjusted annually for inflation).
Virginia currently has a home equity limit of $730,000, so this change could increase allowable home equity—but only up to $1 million. But here’s the part most people miss: your home is only subject to the equity cap if it’s no longer your primary residence. If you’re still living there and receiving in-home care, the cap doesn’t apply. It only kicks in once you’ve entered a nursing facility and left the home behind.
Important: Even if your home is “exempt” for eligibility purposes, it’s not protected from estate recovery. After your death, Medicaid can still come after it. The only way to prevent this is to proactively protect the home with legal planning—often through a properly designed irrevocable trust.
What Happens to Retroactive Medicaid Coverage?
Under current law, Medicaid can pay for care provided up to three months before your application date—if you were financially and medically eligible during that time.
Starting in 2027, retroactive coverage will shrink to:
- One month for most adults under Medicaid expansion.
- Two months for long-term care recipients (seniors and disabled adults).
This change won’t impact many people working with an elder law attorney—because we help clients become eligible before applying. However, for families applying on their own, this shorter window increases the risk of uncovered costs.
The Bottom Line: Medicaid Isn’t Vanishing—But the Clock Is Ticking
Despite the noise, Trump’s new law doesn’t eliminate long-term care Medicaid. But it does create new hurdles—and new opportunities.
If you’re worried about protecting your home, affording care, or understanding how these rules apply to your family, let’s talk. Schedule your private discovery meeting today. Our elder law attorneys serve professionals and families throughout Hampton Roads—including Virginia Beach, Norfolk, Suffolk, Chesapeake, and Portsmouth—and into Northeastern North Carolina, including Moyock and the Outer Banks.
