When one spouse enters a nursing home, the cost of care can be overwhelming. Many families are shocked to learn how quickly private-pay nursing home bills can consume savings that a married couple spent a lifetime building.

Michigan Medicaid can help pay for long-term nursing home care, but the rules are complicated. They involve asset limits, income rules, spousal impoverishment protections, patient-pay amounts, and sometimes probate court proceedings. A recent Michigan Supreme Court case, Gries v Department of Health and Human Services (In re Estate of Sizick), gives families and elder law attorneys important guidance on one Medicaid planning issue involving married couples.

The case is especially important for a married couple where one spouse is in a nursing home and the other spouse is still living at home.

The Problem: Protecting the Spouse at Home

Medicaid law recognizes that when one spouse needs nursing home care, the spouse at home should not be left destitute. The spouse in the nursing home is often called the “institutionalized spouse.” The spouse still living in the community is often called the “community spouse.”

The Medicaid rules allow the community spouse to keep certain assets and, in some cases, a portion of the institutionalized spouse's income. These rules are commonly called the spousal impoverishment rules.

Even with those protections, the standard Medicaid allowance may not be enough in every case. The spouse at home may have ordinary living expenses, medical expenses, home expenses, transportation costs, or other needs that make the standard allowance inadequate.

In some states, married couples facing catastrophic nursing home costs may feel forced to consider a “Medicaid divorce” to protect the spouse who is still living at home. In Michigan, that harsh result has traditionally often been avoided through the use of probate court protective orders, which can direct assets or income to be transferred or paid for the support of the community spouse when the legal requirements are met. That planning tool became more uncertain after the Michigan Court of Appeals' decision in In re Estate of Schroeder, but the Michigan Supreme Court's decision in Sizick restored important flexibility by confirming that probate courts may consider expected Medicaid eligibility before DHHS has made a final Medicaid decision.

What Happened in the Sizick Case?

Jerome and Janet Sizick had been married for more than 60 years. Jerome's health declined, and he entered a nursing home. He later applied for Medicaid to help pay for his care.

Before the Michigan Department of Health and Human Services (“DHHS”) made a final Medicaid eligibility determination, Janet asked the probate court for a protective order. She requested that Jerome's assets and a portion of his income be transferred or paid to her for her support.

The probate court granted relief. DHHS appealed. One of the major issues was whether the probate court could consider the likely availability of Medicaid benefits before DHHS had officially approved Jerome's Medicaid application.

In an earlier case, In re Estate of Schroeder, the Michigan Court of Appeals had held that a probate court could not consider Medicaid-related circumstances until DHHS made an eligibility decision. That rule created a practical problem: DHHS decisions can take weeks or even months, leaving couples to pay high private nursing home rates and drain their savings while waiting for an administrative determination.

The Michigan Supreme Court took a different view, focusing on the practical realities families face while a Medicaid application is still pending.

The Michigan Supreme Court's Holding

The Michigan Supreme Court held that probate courts may consider expected Medicaid benefits before DHHS issues a final eligibility decision—a significant clarification for Michigan Medicaid planning.

The Court explained that the probate court must consider the foreseeable needs of both spouses. That includes the needs of the spouse in the nursing home and the needs of the spouse at home. Because the analysis is forward-looking, the court is not required to ignore Medicaid simply because DHHS has not yet issued a formal decision.

The Court also overruled Schroeder to the extent it required a prior Medicaid eligibility determination before the probate court could consider Medicaid-related circumstances.

Why This Matters for Michigan Medicaid Planning

For families, the practical lesson is this: in the right case, it may not be necessary to wait until DHHS has made a final Medicaid decision before seeking probate court relief for the spouse at home.

That can matter because timing is often critical. Nursing home bills may be accruing. The community spouse may need income to remain safely at home or to pay for their own care in assisted living. The Medicaid application may still be pending. DHHS may take time to process the case. A delay can create significant financial pressure.

The Sizick decision gives probate courts more flexibility to consider the real-world financial situation facing both spouses.

This Does Not Mean Every Couple Qualifies

The decision is helpful, but it is not a blank check.

A protective order is not automatic. The probate court must still make the required findings under Michigan law. The court must consider the assets, income, needs, and circumstances of both spouses. The spouse requesting support must show actual need, not just a desire to preserve a preferred lifestyle.

The Court also made clear that a protective order cannot simply impoverish the spouse in the nursing home or be used as an end-run around Medicaid. The court still has to consider whether the institutionalized spouse's needs will be met.

In other words, this is a planning tool for appropriate cases, not a do-it-yourself shortcut. An experienced Medicaid planning attorney can help determine when it makes sense to pursue a protective order.

Why Families Should Get Advice Before Spending Down Assets

Many families assume that the only way to qualify for Medicaid is to spend down nearly everything first. That assumption can be costly.

Michigan Medicaid planning may involve several possible strategies, depending on the facts. These may include exempt assets, spend-down planning, funeral planning, asset transfers between spouses, income planning, caregiver issues, trust issues, real estate issues, and, in some cases, probate court protective orders.

The right approach depends on the couple's assets, income, health, marital status, living arrangement, nursing home placement, and timing.

Before making transfers, paying large bills, giving assets away, changing accounts, or spending down savings, it is usually wise to speak with an elder law attorney familiar with Michigan Medicaid planning.

Key Takeaway

The Michigan Supreme Court's decision in Sizick is an important development for married couples facing nursing home care in Michigan. It confirms that a probate court may consider expected Medicaid eligibility before DHHS has made a final Medicaid decision when deciding whether to enter a protective order for spousal support.

For families, the broader message is simple: do not assume that Medicaid planning means simply spending everything down. The rules are more nuanced, and planning early can make a major difference for the spouse in the nursing home and the spouse still living at home. A properly developed Medicaid plan can help protect eligibility, preserve resources where permitted, and provide greater stability for the spouse at home.

If your spouse is in a nursing home or may need nursing home care soon, it is important to get advice before taking action. I'm Andrew Byers, an elder law attorney in Troy, Michigan, and I help families understand their options before they spend down assets or make decisions that may affect Medicaid eligibility. To discuss your situation, you can contact my office through the online form or call me directly at (248) 469-4261. During the initial call, I can answer preliminary questions, gather background information, and help determine whether a more in-depth consultation would make sense.