What it is
Advance Medicaid planning is the legal work done well before care is needed — ideally 5+ years — so that the 60-month lookback has fully expired by the time an application is filed.
The workhorse tool is the Medicaid Asset Protection Trust (MAPT) — an irrevocable, "income-only" trust. The grantor retains rights to income from the trust but not to principal. After the 5-year lookback passes, trust principal is generally not counted as an available resource for Medicaid.
Outright gifting can also work when there is a genuine 5-year runway and the giver truly no longer needs the assets. Timing and documentation matter enormously.
In a handful of states — Florida, Michigan, Texas, Vermont, and West Virginia — the Lady Bird Deed (an enhanced life estate deed) lets an owner keep full control during life and pass real property outside probate at death, which can also help avoid Medicaid estate recovery.
This work should always be done with a licensed elder-law attorney in your state.
Families with a 5+ year runway who want to protect wealth while it's still healthy and early enough to plan.