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.

Washington State May Be First Sate With Payroll-Funded Long Term Care Insurance Benefit.

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Numerous states are considering proposals to create a long-term care insurance programs, many funded by a payroll tax. Washington may be the first to actually enact a plan. Both the Washington State House and Senate have passed legislation, so all that’s required is a House re-vote on a Senate package that differs slightly from the House version. 

The Senate tweaked a few aspects of a proposal passed earlier by the House, so approval appears all but assured. The governor, provider associations and many others have  supported the measure, which would cap the lifetime benefit maximum at $36,500 per person. The governor has promised to sign the bill when presented. 

MyNorthwest reported in an article the sponsor's statements supporting the legislation:

"Democratic State Rep. Laurie Jinkins has introduced the Long Term Care Trust Act, which she says would work similarly to unemployment.  'What we do is create, essentially an insurance program where folks pay a premium of 0.58 of a percent, so 58 cents of every hundred dollars they earn would go into the trust. In return, any time they needed long-term care they’d be able to draw on that,' Jinkins explained. 

Workers of all ages would pay into the program, at a cost of around $24 a month for someone earning $50,000 a year.

That creates a benefit of roughly $37,000 over a person’s lifetime they could take in units of $100.

“That amount of money, for example, would pay for 25 hours a week of in-home care over the course of a year, respite care for one of your family members who was getting care; it would pay for that for maybe five years. So, it’s a pretty significant benefit for people,” Jinkins said.

Providers could start collecting payment from the program beginning in January 2025. The measure covers traditional long-term care services for people needing help with at least three activities of daily living (ADLs), as well as things like in-home care and meal delivery, rides to the doctor, home modifications such as wheelchair ramps, and reimbursements to unpaid family caregivers.  Washington defines more broadly ADLs than does private insurance, which usually triggers benefits when someone requires help with two ADLs. The state would reimburse providers directly. Family caregivers could be paid, though they first would have to go through a training program. 

Premiums of 0.58% of wages would begin being withheld from employees’ checks starting in 2022. Someone earning $50,000 per year would pay a premium of about $24 per month, or $288 per year. Under the Senate version, individuals holding long-term care insurance policies would be exempt.

A participant must work and pay the premium/payroll tax for at least 10 years, with at least five uninterrupted, or three of the last six years. Thus, most current retirees would be ineligible for the program.  

Provider and consumer groups testified in favor of The Long Term Care Trust Act, and nobody testified against it, at a House Health & Wellness Committee hearing in January. Experts say 60 percent of us will need long-term care or support of some sort after we hit 65.

In a House committee hearing,  Dan Murphy, executive director of the Northwest Regional Council explained who the insurance would benefit:

“People need long-term care when they can no longer do basic things themselves. Things like bathing, dressing, getting out of a chair, a bed getting into a car, managing their medications or just even standing, walking around. That’s what we’re really talking about in the assistance lift, when folks can’t any longer do things for themselves.”

An outside study authorized by the Legislature back in 2015 found there is a significant need, with seven of 10 people over 65 years old expected to need this type of care.

Of course the program also benefits the State of Washington.  An outside study found the program would lead to big savings for Medicaid over time, close to $900 million in the 2051-53 biennium.

According to an article in Forbes, although Washington is the first state in the US to enact a public long-term care insurance program other states are considering similar legislation.  "Hawaii has provided a public cash benefit for family caregivers of frail older adults, though it is not really an insurance program. California is considering a ballot initiative on a public long-term care financing program, Michigan and Illinois are studying public programs for those not on Medicaid, and Minnesota has proposed two alternative private financing options for long-term care."  Forbes notes,  though, that the "idea is not universally popular, however. Last year, Maine voters rejected a public plan to help fund home care."

According to Forbes, Washington State is choosing a "front-end insurance model that could begin to cover benefits as soon as participants have a need. It would cover the most people, though its benefit would pay only a small fraction of the costs for someone who needs several years of care."  An alternative model, "called a catastrophic or back-end design, would require participants to pay for the first years of care, but provide lifetime coverage after that.  It would cover fewer people than a front-end plan but would focus on those with the greatest need."

The Forbes article concludes that "[t]he Washington State model would be an important experiment, and it could create momentum for other states to adopt long-term care insurance programs."

Irrevocable "Sole Benefit" Trusts Countable as Medicaid Assets in Michigan

A trio of Michigan cases have invalidated the use of Irrevocable Sole Benefit Trusts in Medicaid planning for marital couples.  A Michigan appeals court has held that assets placed in an irrevocable trust by a Medicaid recipient's spouse are countable assets because the principal in the trust can be paid to or for the benefit of the community (non-institutionalized) spouse.  See,  Hegadorn v. Department of Human Services Director (Mich. Ct. App., No. 329508, June 1, 2017); Lollar v. Department of Human Services Director (Mich. Ct. App., No. 329511, June 1, 2017); and Ford v. Department of Health and Human Services (Mich. Ct. App., No. 331242, June 1, 2017).

Three women entered nursing homes. Their husbands created irrevocable "sole benefit trusts." The trusts allowed the trustee to distribute principal to the husbands as necessary with the expectation that all the resources would be used up during the husbands' lifetimes. The trusts prohibited distribution of assets to the women A few months later, the women applied for Medicaid. The state determined that the trusts were available assets and denied the applications.

The women appealed, arguing that the trusts were not countable assets because they were for the sole benefit of the husbands. After three trials, two trial courts ruled that the assets in the trust were not available, and the state appealed and the Michigan Court of Appeals decided the cases together.

The Michigan Court of Appeals held that the trusts are available assets and reversed the decisions of two trial courts. The court ruled that when states make an initial eligibility determination, "an institutionalized individual’s assets includes not only those that he or she has, but also those that his or her spouse has" (emphasis in the original).  According to the court, because "there was a 'condition under which the principal could be paid to or on behalf of the person from an irrevocable trust,' the assets in the trusts were properly determined to be countable assets."

The cases underscore the challenges consumers and planners face in crafting estate planning documents.  The holdings remind consumers that there are a variety of types and kinds of irrevocable trusts, and that they do not all work the same or accomplish the same objectives.  Competent counsel can and do sometimes misapprehend the planning area and options, particularly when planners rely upon consensus planning, and periodic approval by low level caseworkers.  

The best long term care plans consider and accomplish, if possible, each of the following (in order of priority): 1) adoption of the best available health care plan, including medically necessary home health care in order to avoid unnecessary long term institutional care; 2) adoption of an "Aging in Place" philosophy and incorporation and expression of the philosophy in estate planning documents; 3) adoption and maintenance of a sound financial plan to protect income and ensure available resources to pay for alternatives to long term institutional care;  4) settling a revocable trust to protect against guardianship, protect assets and decision-making from institutional control in order to reduce the risk of unnecessary institutionalization; 5) settling an asset protection trust to shield selected assets  for the benefit of a community (non-institutionalized) spouse and to protect inheritance;and; 6) making the home suitable for long term care needs.  

It is vitally important to begin the planning with consideration of the proper Medicare health care option.  Quite simply, every legal and financial plan is made more capable by proper health care insurance planning, and many may be rendered utterly useless by inadequate health care planning.  Please contact our office if you want or need a referral to competent and capable health care planners.  

To read the full opinion, go here.  If you are interested in the history of the use of Sole Benefit Trusts, particularly in Michigan, go here and here, and for an argument advocating why Sole Benefit Trust assets should be protected from Medicaid spend down, go here.