Printable Intent-to-Return-Home Statement

In most states, a nursing home resident’s home stays exempt for Long-Term Care Medicaid as long as the resident intends to return to it, even if a return is not likely. A short, signed statement of that intent is often all that is needed. This page explains how intent to return works, when a statement helps, and provides a plain-language statement you can print, fill in and sign. Some states have their own form; if yours does, use it. Nothing on this page is stored or sent anywhere.

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

Why intent to return matters

For Long-Term Care Medicaid, a home is generally not counted as an asset if the applicant lives in it or, if they are in a nursing home or other medical institution, intends to return to it. Under the federal SSI-based rules most states use, intent is subjective: it is the person’s own stated wish, not a medical prediction. A resident with advanced illness can still intend to return. Some states apply additional rules, such as a time limit or a requirement that return be medically likely, so check your state guide.

Intent to return also matters for:

The home equity limit, which applies when no spouse or protected child lives in the home. See Home equity limits.
Liens. Some states may place a lien on the home of a resident who cannot reasonably be expected to return; stated intent and medical evidence can be relevant. See Estate recovery.
The income deduction for home upkeep. Some states let a resident expected to return home within six months keep part of their income to maintain the home, as a deduction from the patient liability. See Patient liability.

Who can sign

The statement should be signed by the resident if they are able. If the resident cannot sign, many states accept a statement from an agent under a power of attorney, a guardian or an authorized representative, stating the resident’s intent as they understand it. A resident who lacks capacity can still be treated as intending to return, based on what they expressed before or what their representative states, depending on state rules.

When to sign

At the time of application, if the resident owns a home and no spouse or protected relative lives there.
At renewal, if the state asks again.
If anything changes, such as the home being listed for sale or rented.

Keep a copy with the application records.

The statement

Statement of Intent to Return Home

Name of resident: ______________________________________

Date of birth: ____________________ Medicaid case number (if known): ____________________

Address of home: _______________________________________________________________

Current facility: _______________________________________________________________

Date admitted: ____________________

I, the resident named above, own (or have an ownership interest in) the home at the address listed. I am currently living in the facility named above to receive care. It is my intent to return to my home. I understand that this statement is about my intent, and that I may not be able to return.

Signature of resident: ______________________________ Date: ____________

If the resident is unable to sign:

I am the resident’s (circle one) agent under power of attorney / guardian / authorized representative. To the best of my knowledge, it is the resident’s intent to return to the home listed above.

Name: ______________________________ Signature: ______________________________ Date: ____________

Relationship to resident: ______________________________

How to use the statement

Print the page and fill in the blanks by hand.
Have the resident sign if they can. Otherwise, the representative signs the second section.
Make copies. Send one to the caseworker with the application or when asked, and keep one.
Use the state’s form instead if the caseworker provides one.
Keep the home in usable condition and the insurance current. While the resident intends to return, the home is still theirs to maintain.

What intent to return does not do

It does not stop estate recovery. After death, the state may seek repayment from the home if it is part of the estate, unless an exception or hardship waiver applies. See Estate recovery.
It does not override the home equity limit. If equity is over the state’s limit and no spouse or protected relative lives in the home, coverage can be denied even with a statement.
It does not protect rental income. If the home is rented, the rent counts as income.
It may not apply forever in every state. Some states have time limits or additional tests.

If the home is sold

If the resident decides not to return, or the home is sold, the statement no longer applies. Sale proceeds become a countable asset. Plan the sale with the Medicaid rules in mind. See Selling the home.

Examples

A widow with dementia. Clara, 91, has advanced dementia and lives in a nursing home. Before her illness she often said she wanted to die at home. Her daughter, her agent under a power of attorney, signs the statement on her behalf. The state accepts it, and Clara’s home, with equity under the state’s limit, stays exempt.

A man who changes his mind. Leo, 84, signs a statement when he enters a nursing home. A year later he tells his son he wants the house sold. The son reports the change, lists the house and plans for the proceeds, which will count once received.

Common approaches states take

States generally follow one of a few approaches to intent to return:

Subjective intent. The home stays exempt as long as the resident says they intend to return, with no time limit. This is the approach under the SSI rules many states follow.
Intent plus a time limit. Some states treat the home as exempt for a set period after admission, after which it may count unless a spouse or dependent relative lives there or the resident is likely to return.
Intent plus medical likelihood. A few states ask whether a return is medically likely, sometimes with a physician’s statement.

Whichever approach applies, the home equity limit and estate recovery rules still apply separately. Your state guide describes the rule there.

Keeping the home ready

Intent is more convincing, and the home is better protected, when the household is kept up:

keep homeowners insurance in force and tell the insurer the home is temporarily unoccupied, if required by the policy;
keep utilities on at a level that prevents damage, such as frozen pipes;
pay property taxes on time;
arrange for someone to check the home regularly;
keep furniture and belongings in place.

The costs of maintaining the home are usually paid from the resident’s own funds or by family. Some states allow a deduction from the patient liability for home upkeep when a return is expected within six months.

If a family member wants to move in

A family member may live in the home while the resident is in care. If the family member is a spouse, a child under 21 or a blind or disabled child, the home is exempt regardless of intent and the equity limit does not apply. Other relatives may help keep the home exempt in some states if they are dependent on the resident. If the family member pays rent, the rent is income to the resident.

Getting experienced help

Intent to return keeps many homes exempt, but it is only one part of protecting a home. A Certified Medicaid Planner, working with an attorney where needed, can explain how your state treats intent, liens and estate recovery and whether other planning makes sense. As a rough guide, published fees for full planning range from about $2,500 to $15,000 or more and hourly help from about $150 to $600.

Frequently asked questions

Does the resident have to be likely to return? Under the SSI-based rules most states use, no; intent is what matters. Some states apply stricter tests.

Can family members live in the home? Yes. A spouse or dependent relative living there can independently keep the home exempt.

Do I need a lawyer to sign this? No. It is a simple statement. Some families have it notarized, which is not usually required.

What if the state asks for a doctor’s statement? Some states ask for medical evidence in certain situations, such as for a home upkeep deduction. Provide what is asked.

Should the statement be updated? If the state asks again at renewal, or if circumstances change, sign a new one with the current date.

Can intent be stated verbally? Some caseworkers will note a verbal statement, but a signed written statement is clearer and easier to prove later.

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