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.

New Federal Cap on Home Equity for Medicaid Long-Term Care: What It Means for Planning

A significant change to Medicaid rules is coming in 2028 that will affect many homeowners, especially those in higher-cost housing markets. On July 4, 2025, the Budget Reconciliation Act of 2025 (often called the “One Big Beautiful Bill”) was signed into law. One of its provisions creates a new nationwide cap on home equity for people seeking Medicaid coverage for long-term services and supports (LTSS), including both nursing home care and home- and community-based services (HCBS).

What Changed?
Previously, federal law set a minimum home equity limit (approximately $752,000 in 2026) that states could raise up to a higher amount (approximately $1,130,000 in 2026). Both figures were adjusted annually for inflation. Twelve states plus the District of Columbia had chosen the higher limit.
Starting January 1, 2028, the rules change dramatically:

• There is now a hard national ceiling of $1,000,000 on home equity.
• This cap is frozen; it will not increase with inflation in future years.
• States can no longer set a higher limit for non-agricultural homes.
• The change applies to both institutional care and HCBS waivers.

Illustration of the Change

Home Equity Amount	Current Rule (through 2027)	New Rule (effective Jan. 1, 2028)	Likely Outcome for Medicaid LTSS
$800,000	Exempt in all states	Exempt	Qualifies
$1,050,000	Exempt in high-limit states (NY, CA, etc.)	Ineligible	Disqualified
$1,200,000	Ineligible in most states	Ineligible	Disqualified
Agricultural-zoned home	Follows prior inflation-adjusted rules	Still follows prior inflation-adjusted rules	Better protection.

Important Exceptions
The home remains fully exempt (no equity limit applies) if:

• A spouse, child under 21, or blind/disabled child of any age lives in the home.
• The home is on property zoned for agricultural use (these homes keep the old inflation-adjusted rules).

States must still offer hardship waivers in cases of demonstrated need.  There are also federal provisions that allow transfer of the home to qualified individuals, such as certain child caregivers residing in the home for a period of two years, if the applicant was medically qualified for skilled nursing care for at least the two-year period. Why This Matters for Aging in Place
This change makes it harder for “house-rich, cash-poor” seniors to access Medicaid-funded home care or nursing home care without first reducing (spending down) their home equity. In high-cost areas (California, New York, Massachusetts, Hawaii, Colorado, etc.), even modest homes can push equity over $1 million. Because the cap is frozen, the problem will grow worse every year as home prices rise.
For families committed to aging in place, this development actually strengthens the case for proactive planning. Relying on Medicaid HCBS may become less reliable for homeowners with significant equity. Having private resources protected and/or available becomes even more valuable.Does This Change Impact an Existing or Contemplated  Medicaid Asset Protection Trust (MAPT)?
Short answer: No, it does not suggest you should fund a MAPT with fewer assets.
Here’s why:

• The new home equity cap is a separate rule that applies only to the primary residence when determining whether the home itself is an exempt resource.
• A Medicaid Asset Protection Trust (MAPT) is designed to protect countable assets (cash, investments, CDs, non-primary real estate, etc.) from Medicaid’s strict $2,000 asset limit.
• The home equity cap does not change the general asset test or how MAPTs work for non-home assets.

In other words, the new law does not mean you should put less money into a MAPT. If anything, it makes comprehensive asset protection planning more important. With the home potentially becoming a disqualifying factor for more people, protecting your other assets in a properly drafted MAPT gives you greater flexibility and resources while you pursue Medicaid eligibility on the home (if your equity is under the limit).
Note on putting the home itself into a MAPT: In most states, transferring your primary residence into a MAPT can remove it from the home equity calculation (because it is no longer “owned” by you personally). However, this strategy has important trade-offs, including the 5-year lookback period and state-specific rules. In a few states, placing the home in a MAPT can make it a countable asset. This is a complex decision that requires individualized legal advice.Bottom Line and Planning Recommendations
The new $1 million frozen home equity cap is another reminder that Medicaid is a needs-based program with increasingly strict rules. For families who want real choice about where and how they age, the best strategy remains proactive planning well before care is needed.
If you or a loved one owns a home with equity approaching or exceeding $1 million (or if you live in a state that previously allowed higher limits), now is an excellent time to:

• Review your current home equity and long-term care plans;
• Consider whether strategies to manage home equity make sense before 2028;
• Evaluate or establish a Medicaid Asset Protection Trust for other assets; and,
• Explore hybrid long-term care insurance or other private-pay options that support aging in place

This change does not eliminate the value of planning — it actually highlights why early, thoughtful elder law planning is more important than ever.