Michigan Supreme Court Medicaid Ruling: A Win for Families — But a Cautionary Tale for Proactive Planning

The Michigan Supreme Court Ruling in In re Estate of Sizick restores an important Medicaid planning tool for married couples while highlighting the ongoing risks of crisis-driven legal proceedings. The case, also styled Gries v. Department of Health and Human Services, clarifies that probate courts may consider expected Medicaid benefits before the Michigan Department of Health and Human Services (DHHS) issues a final eligibility determination when evaluating a petition for a protective order. This article expands on the practical implications of the ruling, drawing from both the Court’s opinion and the thoughtful analysis by Michigan elder law attorney Andrew R. Byers in his June 30, 2026 article, “Michigan Supreme Court Clarifies an Important Medicaid Planning Tool for Married Couples.”

The Facts and the Holding

Jerome and Janet Sizick had been married more than 60 years when Jerome’s health declined and he entered a nursing home. While privately paying for care and before DHHS made a final Medicaid decision, Janet petitioned the Saginaw Probate Court under MCL § 700.5401(3) for a protective order transferring Jerome’s assets to her and awarding her monthly support. The probate court granted the order.  The State Department of Health and Human Services contested the decision.

After a complicated legal and factual path, including Jerome's subsequent and intervening death, and two Court of Appeals decisions that vacated the order based on a prior Supreme Court case, In re Estate of Schroeder,  the Michigan Supreme Court reversed the appellate courts, upheld the original protective order, and clarified its prior holding in In re Estate of Schroeder.   

The Court held that probate courts may consider the projected availability of Medicaid benefits when assessing the foreseeable needs of both spouses under MCL § 700.5401(3)(b). It expressly overruled Schroeder to the extent that case required a final Medicaid eligibility determination before protective orders could be obtained.  The Court also found the appeal was not moot despite Jerome’s prior death, because Medicaid benefits can be awarded retroactively and the protective order could still affect pending administrative hearings and the estate’s obligations.

Positive Aspects: Recognition of Balanced Property Interests

The decision is positive in its recognition that the community spouse has a legitimate interest in support that must be balanced against the institutionalized spouse’s needs. By allowing a forward-looking analysis, the Court acknowledged the practical reality that nursing-home costs accrue rapidly while applications are pending. Families should not be forced to deplete savings simply because the administrative process is slow.  This balancing of interests reinforces the federal spousal impoverishment protections under Medicare and gives Michigan probate courts meaningful tools to prevent community-spouse impoverishment.

Troubling Aspects: The Cost and Complexity of the Appeal Process

While the outcome is favorable, the procedural history is troubling. The case wound through multiple levels of review over several years. Jerome died while the appeal was pending. The family incurred significant legal costs that might have been avoided with earlier, more comprehensive planning. Even a “win” at the Supreme Court level came after prolonged uncertainty and private-pay nursing-home bills. This underscores a recurring theme in elder law: litigation, even successful litigation, is an expensive and imperfect substitute for proactive planning.

Impact on Aging-in-Place Planning

Sizick strengthens a useful crisis tool, but it does not change the fundamental truth that aging-in-place planning remains the superior path. Families who implement an Aging-in-Place Plan, fund a  properly designed Medicaid Asset Protection Trust (MAPT), maintain appropriate beneficiary designations, and coordinate powers of attorney and trusts well before a health crisis often avoid the need for emergency probate petitions altogether.  Protective orders can help in the right case, but they require court findings of actual need, careful balancing of both spouses’ interests, and ongoing judicial oversight. They are not a routine substitute for advance planning that keeps the community spouse securely at home without court intervention.  As Attorney Byers correctly notes, families should not assume that the only option is to spend down nearly everything. Michigan Medicaid planning involves multiple strategies, exempt assets, inter-spousal transfers, income planning, trusts, and, when appropriate, protective orders. Timing and professional guidance matter enormously.

Why This Opinion Has Limited Reliability in Missouri and OhioThe Sizick decision rests heavily on Michigan’s specific statutory framework under the Estates and Protected Individuals Code (particularly MCL 700.5401). Ohio and Missouri do not have an identical mechanism.

• Ohio allows increases to the Community Spouse Resource Allowance (CSRA) or Minimum Monthly Maintenance Needs Allowance (MMMNA) through a State Hearing or court order in exceptional circumstances under federal law and Ohio administrative rules. However, it does not rely on the same broad probate “protective order” process used in Michigan.
• Missouri primarily uses the standard federal CSRA and “Division of Assets” rules. While court orders for support can sometimes play a role, Missouri does not have a well-developed body of case law treating probate protective orders as a routine Medicaid planning tool in the same way Michigan does.

Attorney Byers explained the practical distinction: 

"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." 

Because Sizick interprets a Michigan-specific statute, it is persuasive authority at best,  and of limited legal value, in Ohio or Missouri courts. Practitioners and their clients in those states must rely on state specific statutes, administrative rules, and case law when seeking to increase spousal allowances.

Conclusion

In re Estate of Sizick is a welcome clarification for Michigan families. It restores flexibility and recognizes the real-world needs of the community spouse. Yet the long, expensive path the Sizick family traveled remains a cautionary tale. The best protection for both spouses is still proactive aging-in-place and Medicaid planning long before a nursing-home admission. When crisis planning becomes necessary, experienced counsel is essential. There is no reliable substitute for a well-designed plan that keeps options open and court involvement to a minimum.