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.

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

Some cases stand for the black-letter rule or law determined by the court.  Some cases serve as object lessons regarding the costs, uncertainties, and inherent risks of litigation. The recent case of In re Estate of Sizick (Mich. Mar. 18, 2026), serves as both:  the decision is favorable to seniors and their families, but the case, nonetheless, serves as an object lesson regarding the cost NS complexities of Medicaid, and why proactive aging-in-place planning and Medicaid asset protection planning are superior alternatives. 

In a unanimous decision, the Michigan Supreme Court ruled that probate courts can consider the future availability of Medicaid benefits when deciding whether to issue a protective order transferring assets and income to a community spouse. The Court overruled prior precedent that had limited this forward-looking approach, giving married couples facing nursing home care more tools to protect the healthy spouse from impoverishment.
While this is a positive development for Michigan families already in crisis, the case itself reveals a much more profound lesson: the Sizick family endured years of expensive, stressful, and complicated litigation, including multiple trips to the Court of Appeals and ultimately the Michigan Supreme Court, to achieve what proper advanced planning could have accomplished with greater certainty and ease, and far less expense.
The holding in this case does not apply to our clients in Ohio or Missouri. Neither Ohio nor Missouri offers the same type of broad pre-eligibility probate court protective order that Michigan now allows after In re Estate of Sizick (where the court can proactively transfer most or all assets to the community spouse while considering future Medicaid eligibility).
Ohio

• Ohio follows the standard Community Spouse Resource Allowance (CSRA) rules: generally 50% of countable assets up to the federal maximum (~$162,660 in 2026), with a minimum floor.
• Ohio does allow Spousal Refusal (“Just Say No”) in certain situations, where the community spouse refuses to use their assets for the institutionalized spouse’s care. This can help protect more assets but comes with risks (potential future recovery claims by the state).
• Community spouses can request a fair hearing or, in some cases, a court order for additional support, but Ohio does not have the same proactive, forward-looking protective order authority as Michigan’s probate courts post-Sizick.

Missouri

• Missouri also uses the standard federal Division of Assets process (sometimes called “spousal share”).
• The community spouse generally receives 50% of the couple’s countable assets, subject to the current minimum (~$32,500) and maximum CSRA (~$162,660 in 2026).
• This is handled administratively through the Missouri Medicaid agency (MO HealthNet) during the eligibility process.
• While a court order can sometimes increase the income allowance (MMMNA), Missouri does not have a robust mechanism for a probate court to issue a broad protective order transferring excess assets before Medicaid applies, as Michigan now permits.

Bottom Line for Planning

Both Missouri and Ohio rely primarily on the standard CSRA calculation and administrative processes rather than on expansive court-protective orders. This makes advanced planning (Medicaid Asset Protection Trusts established 5+ years in advance, proper titling of assets, spousal annuities, etc.) even more important and valuable in Ohio and Missouri to protect assets beyond what the standard CSRA allows. The High Cost of Waiting
By the time Jerome Sizick entered a nursing home, the family had to petition the probate court for a protective order, fight DHHS objections, and navigate a lengthy appeals process. What should have been a straightforward asset-protection step accomplished years before, turned into a multi-year legal battle with significant attorney fees, court costs, and emotional strain.
This complicated procedural posture highlights a reality we see often in elder law: reacting to a crisis almost always costs more in money, time, and peace of mind than planning and preparing in advance.A Better Path: Balanced Aging-in-Place and Medicaid Asset Protection Planning
With proper planning while both spouses were still healthy and had capacity, the Sizicks could likely have:

• Deployed a well-drafted Medicaid Asset Protection Trust (MAPT) to shelter assets from future long-term care costs while preserving eligibility for the community spouse.
• Built a strong Aging-in-Place Plan (financial and legal planning to enable home modifications, in-home care coordination, family caregiver agreements, and long-term care insurance review) to delay or avoid institutionalization altogether.
• Included clear, comprehensive powers of attorney and healthcare directives to reduce the need for court intervention.

A balanced approach established five years before need would have given the family far greater control, privacy, and predictability, without the need for expensive probate court battles after a health crisis.The Takeaway for Our Readers
Court victories like Sizick are helpful, at least in this case for Michiganders, but they are not a substitute for robust proactive planning. The best time to protect your home, savings, and spouse’s security is now — while you still have full control and before a health event forces you into reactive, high-cost legal proceedings.
If you or a loved one is concerned about future long-term care costs, we strongly encourage you to meet with an experienced elder law attorney to explore a customized aging-in-place plan combined with effective Medicaid protection strategies.
Don’t wait until a crisis forces you into years of litigation. Proactive planning remains the most powerful and cost-effective way to protect your family’s future.