John Diamantis, founder of Heritage Law, helps Nebraska and Iowa families plan for the cost of long-term care through Medicaid, whether you are planning years in advance or facing an urgent nursing home placement right now. Medicaid planning means legally structuring income and assets to meet Nebraska’s and Iowa’s strict eligibility rules while preserving as much as possible for a spouse or family. It requires someone who understands both the legal tools and the specific requirements of Nebraska DHHS and Iowa HHS.
Medicaid does not pay for long-term care simply because someone needs it. Applicants have to meet strict income and asset limits set by the state. Nebraska and Iowa both review the five years of financial history before an application (known as the look-back period) to check for transfers made specifically to qualify. Medicaid planning is the legal work of structuring your finances within these rules, using tools like asset protection trusts, spend-down strategies, and in some cases a Qualified Income Trust, so that a spouse or family is not left with nothing.
These are two different situations, and the right approach depends on which one you are in.
Proactive planning is for families who want to plan years before care is actually needed. This gives you the most options, since strategies completed well outside the five-year look-back period carry no penalty risk, and there is time to structure things carefully.
In a Medicaid crisis right now?
If a spouse or parent is already in a nursing home, or admission is expected within the next few months, you are in crisis planning territory. This is a different, faster process, but real options still exist even after care has begun. The sooner you reach out, the more of those options remain available.
Medicare is federal health insurance available to most people 65 and older, regardless of income. Medicaid is a joint federal and state program based on financial need, and it is Medicaid, not Medicare, that generally pays for long-term nursing home care. Many families are surprised to learn Medicare does not cover extended nursing home stays.
Nebraska applies two separate tests: an income test and a stricter asset test. In 2026, a single applicant is generally limited to $4,000 in countable assets. When one spouse needs care, the community spouse can keep a larger share of the couple’s assets under the Community Spouse Resource Allowance (currently a minimum of $32,532 and a maximum of $162,660). Income rules are more flexible because Nebraska is a medically needy state. These figures change periodically, so we confirm the exact numbers that apply to your situation rather than relying on general published limits.
Iowa applies a separate income test and asset test. In 2026, a single applicant is generally limited to $2,000 in countable assets. When one spouse needs care, the community spouse can keep a larger share of the couple’s assets under the Community Spouse Resource Allowance (currently a minimum of $32,532 and a maximum of $162,660). Iowa is an income-cap state; the 2026 income limit is $2,982 per month. Applicants over that amount often use a Medical Assistance Income Trust (MAIT). These figures change periodically, so we confirm the exact numbers that apply to your situation.
Nebraska and Iowa both review financial transactions from the five years before a Medicaid application to check for asset transfers made to qualify for benefits. Transfers made during this look-back period can result in a penalty period during which Medicaid will not pay for care. Proactive planning done well before this window matters is one of the most effective ways to avoid this problem.
A Miller Trust, also called a Qualified Income Trust, is a legal tool used when someone’s income is too high to qualify for Medicaid long-term care under normal rules, but not high enough to actually pay for care privately. Income is directed into the trust to bring the applicant’s countable income under the Medicaid limit, allowing them to qualify. Iowa has its own version of this tool, called a Medical Assistance Income Trust, or MAIT. This is generally an Iowa-specific need. Nebraska cases typically do not require this particular tool, though we review each situation individually.
No. This is what crisis Medicaid planning addresses. Even after someone has entered a nursing home, there are still legal strategies that can protect assets for a spouse or family while working toward Medicaid eligibility. The options are different from proactive planning done years in advance, but they are real, and time still matters. The sooner you reach out, the more options are typically available.
You can apply on your own, but Medicaid’s rules around asset transfers, spend-down strategies, and trusts are complex, and mistakes made during the application process can be costly and difficult to fix. An attorney who works with Nebraska DHHS and Iowa HHS regularly can help you structure your situation correctly before you apply, not just fill out the paperwork.
Whether you are planning ahead or facing a crisis, we will tell you honestly where you stand.
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