A semi-private nursing home room costs more per year than the median American household earns, and Medicare pays for almost none of it. That fact drives an entire area of practice built around a single statutory provision: the sixty-month look-back that penalizes uncompensated transfers made before a Medicaid application. This article explains what Medicaid actually covers and what Medicare does not, walks the eligibility rules for income and countable resources and the exempt assets that surprise families, and works the transfer penalty in detail including how the penalty period is computed and why its start date makes late planning so dangerous. It then covers the spousal impoverishment protections that let a community spouse keep a house and a share of the assets, the estate recovery program that reclaims what Medicaid paid, and the planning techniques that remain lawful after the Deficit Reduction Act tightened the rules: exempt transfers to a spouse or a disabled child or a caretaker child, first-party and pooled and third-party special needs trusts, qualified income trusts in income-cap states, and compliant annuities and promissory notes. It closes with the ethical problems this practice creates and the alternatives families should consider before any of it.