Medicaid Asset Protection Trusts (MAPTs)

A Medicaid asset protection trust (often shortened to MAPT, and sometimes called an irrevocable income-only trust) is a trust designed so that the assets inside it do not count toward Long-Term Care Medicaid’s asset limit. It is one of the most powerful advance-planning tools, but it only works if it is set up and funded well before care is needed, and it requires giving up control of the money. This guide explains how these trusts work, who they tend to fit, and the risks.

Figures change periodically. Double-check current amounts before relying on them.

The short version

A MAPT is an irrevocable trust. Once assets go in, the person who created it cannot take them back or direct how the principal is used.
Moving assets into the trust is treated as a transfer for Medicaid purposes. If the person applies for Long-Term Care Medicaid within the 60-month look-back, the transfer can cause a penalty period.
After five years, the assets in the trust are generally not counted and are not subject to a transfer penalty.
The person who created the trust can usually receive the trust’s income, but not the principal. Any income they receive counts as income for Medicaid.
An attorney prepares the trust. Drafting details matter a great deal.

How a MAPT works

A trust is a legal arrangement in which one person (the trustee) holds and manages property for the benefit of others (the beneficiaries). In a typical MAPT:

The grantor (also called the settlor or trustor) is the older person or couple who creates and funds the trust.
The trustee is usually an adult child or another trusted person. In most plans it is not the grantor or the grantor’s spouse.
The beneficiaries are usually the grantor’s children or other heirs, who receive the principal after the grantor’s death.
The grantor may be entitled to the trust’s income (for example, interest and dividends) during life, but the trust document forbids paying any principal to the grantor or the grantor’s spouse.

Federal law sets out how Medicaid treats trusts (Social Security Act section 1917(d), 42 U.S.C. 1396p(d)). For an irrevocable trust, any part of the trust that could be paid to the applicant under any circumstances is counted as the applicant’s asset. Any part that could never be paid to the applicant is treated as a transfer of assets, made on the date the trust was funded (or the date payment to the applicant was cut off). That is why a MAPT is drafted so the principal can never be paid to the grantor: the principal then becomes a transfer subject to the look-back rather than a countable asset.

The five-year look-back and the trust

For transfers into a trust, the look-back period is 60 months, the same as for other transfers in most states. (California is phasing in a shorter look-back under its own rules.) What this means in practice:

If the grantor applies for Long-Term Care Medicaid more than five years after funding the trust, the trust assets are generally not counted and no penalty applies.
If the grantor applies within five years, the transfer into the trust is reviewed like a gift. The state divides the value transferred by its penalty divisor to get a penalty period, during which Medicaid will not pay for long-term care.
Each addition to the trust starts its own five-year clock.

Because of this, a MAPT is usually an advance-planning tool for people who are healthy enough that care is not expected for at least five years, and who have enough other income or savings to pay for care if it is needed sooner.

What usually goes into a MAPT

The home. Many families put the home in a MAPT. The grantor can usually keep living there. Because the home is often exempt anyway, the main purpose is protecting it from estate recovery and from being counted if the grantor moves permanently into care.
Savings and investments that are not needed for day-to-day living.
Other real estate, such as a vacation home or rental property.

Retirement accounts such as IRAs are usually not put in a MAPT, because moving them would mean cashing them out and paying income tax. They are handled in other ways.

What the grantor gives up

The protection comes at a real cost in control:

The grantor cannot take back the principal or change the beneficiaries in most designs (some trusts give the grantor a limited “power of appointment” to change shares among family members).
The grantor cannot use the principal for their own needs, even in an emergency. The trustee may be able to distribute principal to the children, who could choose to help, but they are not required to.
The trustee must follow the trust terms and act for the beneficiaries.

Families should be comfortable living on their income and remaining assets before putting a large share of their savings in a MAPT.

Tax considerations

Tax treatment depends on how the trust is drafted, and a tax professional should review it. Common features:

Many MAPTs are drafted as “grantor trusts” for income tax purposes, so the grantor reports the trust’s income on their own return, and the home may keep the grantor’s property tax exemptions.
Many are drafted so the assets are included in the grantor’s estate for tax purposes. This can allow heirs to receive a “stepped-up” cost basis at death, which may reduce capital gains tax when they sell.
If the home is sold during the grantor’s life, some trusts are drafted to preserve the capital gains exclusion for a principal residence.

These outcomes are not automatic. They depend on the trust language.

Trusts that do not protect assets

Revocable living trusts do not protect assets from Medicaid at all. Because the grantor can take the assets back, everything in a revocable trust counts. See Revocable vs. irrevocable trusts.
An irrevocable trust that lets the trustee pay principal to the grantor “if needed” is counted in full, because the principal could be paid to the grantor.
A trust funded with the applicant’s assets but naming a disabled person under 65 as beneficiary follows different rules. See Special needs trusts.

A simple example

Robert and Linda, both 70 and in good health, own a home worth $400,000 and have $300,000 in savings, plus pensions and Social Security. In 2026 they ask an attorney to set up a MAPT. They move the home and $150,000 into the trust, with their daughter as trustee. They keep $150,000 and their income outside the trust for daily life and emergencies.

If neither needs nursing home care until after 2031, the home and the $150,000 in the trust are generally not counted and cannot cause a penalty. If Robert needed care in 2028, the transfers would fall inside the look-back. The state would figure a penalty by dividing $550,000 by its divisor. In a state with a divisor of about $11,000 a month, that would be about 50 months, so they would need to pay privately during that time using the money they kept, or consider other options. Because the home was exempt while Linda lived there, a planner would also look at whether the home transfer itself was a problem in their state.

This example is simplified. The exact result depends on the state’s rules and the trust’s terms.

Who MAPTs tend to fit

People who expect not to need long-term care for at least five years.
People with enough income and savings outside the trust to live comfortably and pay for care if it comes sooner.
People whose main goal is passing on a home or savings to children.
Couples who want to protect assets for the family beyond what the spousal rules allow.

They tend not to fit people who already need care, who need their savings to live on, or whose family relationships make giving up control risky.

Common mistakes

Funding the trust too late, inside the look-back, without a plan for the penalty.
Using a generic or online trust form that leaves a path for principal to reach the grantor.
Naming the grantor or the grantor’s spouse as trustee in a way that gives them control.
Leaving accounts outside the trust that the grantor needs, then pulling money back informally.
Ignoring the tax effects.
Forgetting that the grantor’s income from the trust still counts for Medicaid.

Working with professionals

A MAPT is a legal document, and an attorney prepares it. Because the trust interacts with the look-back, the spousal rules, taxes and estate recovery, many families also work with a Certified Medicaid Planner to decide whether a trust makes sense at all, how much to put in, and how it fits with the rest of the plan.

Frequently asked questions

Can I be the trustee of my own MAPT? Usually not, or only in narrow ways, because control over principal can make the trust countable. An attorney will explain the options.

Can I still live in my home if it is in the trust? Generally yes. Most MAPTs let the grantor live in the home for life.

What happens when I die? The trustee distributes the assets to the beneficiaries as the trust directs. Because the assets are not in the grantor’s name, they are generally outside probate, and in most states outside Medicaid estate recovery.

Can the trust be changed? Some states allow changes with court approval or the consent of all beneficiaries, and some trusts include limited powers to adjust shares. Major changes can affect Medicaid treatment.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.