The caregiving vocabulary — in plain English.

October 15 to December 7 each year. The window when Medicare beneficiaries can change plans (Original Medicare ↔ Medicare Advantage, switch Part D, etc.). Coverage starts January 1.

See also: Medicare

Pennsylvania's SHIP program, run through the PA Department of Aging and county AAAs. 1-800-783-7067.

See also: SHIP, Medicare

California's SHIP program. Free, unbiased Medicare counseling through county HICAP offices. 1-800-434-0222.

See also: SHIP, Medicare

New York's SHIP program, run through the NY State Office for the Aging and county AAAs. 1-800-701-0501.

See also: SHIP, Medicare

A surcharge added to Medicare Part B and Part D premiums for higher-income enrollees. Income is from the tax return two years prior. Appealable via SSA-44 for 'life-changing events.'

See also: Medicare, Part D

Federal health insurance for adults 65+ and certain younger adults with disabilities. Four parts: A (hospital), B (medical), C (Medicare Advantage), D (drugs). Parts A and B together are 'Original Medicare.'

See also: Medigap, Medicare Advantage, Part D, IRMAA

A private alternative to Original Medicare. Plans include Parts A, B, and usually D; many include dental/vision. Provider networks are typically narrower than Original Medicare; extra benefits offset that.

See also: Medicare, Medigap

Private insurance that pays the out-of-pocket portions Original Medicare leaves you with. Sold by letter (Plans G, N, F for those eligible). State rules govern guaranteed-issue periods and re-enrollment.

See also: Medicare, Medicare Advantage

Medicare's outpatient prescription drug benefit. Sold by private insurers but standardized federally. 2026 introduces a $2,000 annual out-of-pocket cap.

See also: Medicare

Florida's SHIP program. Free, unbiased Medicare counseling through volunteers in every Florida county. 1-800-963-5337.

See also: SHIP, Medicare

Federally-funded free Medicare counseling, delivered through state programs (often via the state Department of Aging). Each state names its program differently: SHINE (FL), HICAP (CA), HIICAP (NY), APPRISE (PA), SHIP (TX/AZ).

See also: Medicare, SHINE, HICAP, HIICAP, APPRISE

Arizona's Medicaid agency — pronounced 'access.' Runs ALTCS (long-term care) and broader Medicaid programs. 1-855-432-7587 for ALTCS.

See also: ALTCS, Medicaid

Arizona's Medicaid long-term care program, administered through AHCCCS via managed care organizations. Covers nursing home, assisted living (via Adult Care Homes), and in-home services. 1-855-432-7587.

See also: Medicaid LTC

New York Medicaid program letting recipients hire and direct their own caregivers, including family members (often adult children). Pays the caregiver directly. Distinctive in the US for its scope.

See also: Medicaid LTC

Pennsylvania's Medicaid managed-care program for seniors and adults with disabilities. Administered through PA DHS via three MCOs serving designated regions. Replaces older PA waivers.

See also: Medicaid LTC

Maximum countable assets the non-applying spouse can retain when their partner enters Medicaid LTC. Federal: ~$157,920 in 2025. Adjusts each January.

See also: MMMNA, Spousal refusal

California's Medicaid (Medi-Cal) agency. Issues policy through All County Welfare Director Letters (ACWDL) — the source documents for tracking Medi-Cal rule changes.

See also: Medicaid

Medicaid services delivered outside an institutional setting — at home, in assisted living, or in adult day programs. Most states operate one or more HCBS waivers under §1915(c) of the Social Security Act.

See also: Medicaid LTC

Texas's umbrella agency for Medicaid, including STAR+PLUS (LTC). Apply through YourTexasBenefits.com. 1-877-541-7905.

See also: STAR+PLUS, Medicaid

California's program paying for in-home care for Medi-Cal-eligible seniors and people with disabilities. Recipients can hire family members. County-administered.

See also: Medicaid LTC

A Medicaid state where applicant income must be below a fixed cap (currently ~$2,901/month for a single applicant). Above the cap, a Miller trust (QIT) is used. FL, TX, AZ, PA are income-cap; CA and NY use a 'medically needy' spend-down instead.

See also: Miller trust, Medicaid LTC

The window — 60 months in most states, 30 months for NY community Medicaid and CA — during which uncompensated transfers (gifts, below-market sales) trigger a Medicaid penalty period. The penalty delays eligibility, not denies it.

See also: Medicaid LTC, Transfer penalty

Joint federal-state health coverage for low-income individuals. Administered by states under federal rules. For older adults, the most common path is Medicaid long-term care, which has its own (more restrictive) eligibility rules.

See also: Medicaid LTC, MMMNA, Look-back period

Federal law requires states to seek recovery of Medicaid LTC expenses from a deceased recipient's estate. States vary on scope: probate-only (FL, CA, TX, NY, PA, AZ) vs. expanded (some other states). The home is frequently the only meaningful asset to recover from.

See also: Medicaid LTC

The category of Medicaid that pays for nursing home, assisted living (via waiver), and in-home care. Has separate, stricter eligibility rules than regular Medicaid: low income, low countable assets, 60-month look-back on transfers.

See also: Medicaid, Look-back period, CSRA, MMMNA

Irrevocable trust used in income-cap Medicaid states (FL, TX, AZ, PA) when the applicant's monthly income exceeds the cap (~$2,901/mo in 2026). Excess income is deposited into the trust; the trust then pays the nursing home.

See also: Medicaid LTC, Income-cap state

Minimum income protected for the at-home spouse when their partner is on Medicaid LTC. Income above this from the Medicaid recipient can be diverted to the community spouse. Federal: ~$2,555-3,948/month in 2025. Adjusts each January.

See also: CSRA, Spousal refusal

Combined Medicare + Medicaid program providing comprehensive care for nursing-home-eligible seniors who can still live in the community. PACE centers offer medical, social, and personal care. Limited geographic availability.

See also: Medicaid LTC, HCBS

Florida's Medicaid LTC delivery model. AHCA contracts with several Managed Care Organizations (MCOs) that administer benefits including in-home aides, assisted living waivers, and nursing-home payments.

See also: Medicaid LTC

Under NY SSL §366(3)(a), a community spouse can refuse to make their resources available to the Medicaid applicant. The applicant is then eligible based on their own resources alone; the state may pursue the refusing spouse for recovery, but historically rarely does so successfully.

See also: CSRA, Medicaid LTC

Texas's Medicaid managed-care program for seniors and adults with disabilities. Covers Medicaid LTC services including HCBS waivers. Administered through MCOs by HHSC.

See also: Medicaid LTC

Period of Medicaid LTC ineligibility imposed for uncompensated transfers during the look-back. Length = transferred value ÷ state's monthly LTC private-pay rate. Penalty starts when applicant is otherwise eligible — not at the date of transfer.

See also: Look-back period, Medicaid LTC

Marital property regime under which assets acquired during marriage are jointly owned by both spouses. California, Texas, and Arizona are community-property states (among our six). Federal tax benefit: full double step-up in basis at first spouse's death.

See also: Elective share

A surviving spouse's statutory right to a fraction of the deceased spouse's estate, regardless of the will. Prevents disinheritance of a spouse. Percentages vary (FL: 30% of the elective estate); calculations vary widely state to state.

See also: Probate

State statutes making adult children potentially liable for indigent parents' care. Most states have these on the books but rarely enforce them. Pennsylvania is the conspicuous exception — see Pittas v. Health Care & Retirement Corp (2012).

See also: Medicaid LTC

Document naming an agent to make medical decisions if the principal cannot. Named differently by state: Healthcare Surrogate (FL), Advance Health Care Directive (CA), Medical POA (TX), Health Care Proxy (NY), Health Care POA (PA, AZ).

See also: Living will, MOLST

Legal protection of the primary residence, typically against creditor claims. Wide variation: FL and TX offer unlimited home-value protection (with acre limits); AZ raised its cap to $400,000 in 2022; CA scales by county median.

See also: Medicaid LTC

Trust the grantor cannot modify or revoke (with narrow exceptions). Used for Medicaid asset protection (subject to 5-year look-back), estate-tax planning, and special-needs planning. Trade-off: loss of control.

See also: Medicaid LTC, Look-back period

Document expressing wishes about end-of-life care, especially the use of life-sustaining treatment when recovery is not expected. Sometimes combined with the healthcare POA in a single 'advance directive' document; sometimes separate.

See also: Healthcare POA, POLST

New York's POLST equivalent. Physician-signed medical order under PHL §2977 for patients with serious illness. Pink form; recognized in hospitals, nursing homes, EMS.

See also: POLST, Living will

Legal document authorizing an agent ('attorney-in-fact') to act on the principal's behalf. 'Durable' means it remains effective if the principal becomes incapacitated. Each state has its own statutory form; out-of-state POAs aren't always honored.

See also: Springing POA, Healthcare POA

Medical order signed by a physician (or NP/PA) translating a patient's end-of-life wishes into actionable orders for EMS, hospitals, and facilities. Not a substitute for advance directives — it complements them.

See also: Living will, MOLST

Court-supervised process of distributing a decedent's estate. Validates the will, appoints a personal representative, pays creditors, and distributes assets. Time and cost vary widely by state (CA notably slow and expensive; FL faster with summary administration available).

See also: Revocable trust, Small-estate procedure

Trust the grantor can modify or revoke during their lifetime. Primary use is probate avoidance — assets titled to the trust pass to beneficiaries without going through probate court. Doesn't provide creditor or Medicaid protection.

See also: Probate

Streamlined probate (or skip-probate-altogether affidavit) available when the estate is below a state-set threshold. Threshold varies: $50k (NY, PA) to $200k personal / $300k real (AZ post-2025 HB 2116).

See also: Probate

A POA that takes effect only upon a triggering event — usually a physician's determination that the principal is incapacitated. Slower to activate than an immediate-effect POA. Some states have moved away from springing POAs (NY 2021 reforms simplified this).

See also: POA

Real-estate deed transferring title at death to a named beneficiary, without probate. Authorized in many states including TX (Tex. Est. Code §114.151). Revocable during the grantor's life; the beneficiary takes nothing while grantor is alive.

See also: Probate, Revocable trust

Arizona-specific small-scale (≤10 beds) residential assisted living. Often family-owned. Lower cost than larger ALFs (~$2,500-5,000/mo). One of AZ's defining LTC features.

See also: Assisted living

Daytime program providing social engagement, basic care, and meals at a community facility — usually 5 days/week. Significantly cheaper than full-time in-home aide; provides respite for family caregivers. Among the most under-used LTC tools.

See also: HCBS

Group residence providing meals, social activities, and basic personal care (medication management, bathing assistance). Distinct from skilled nursing — residents are generally ambulatory. Cost typically $4,000-$7,500/mo private pay; Medicare doesn't cover; some Medicaid waivers do.

See also: Nursing home, Memory care

Multi-level senior community offering independent living, assisted living, memory care, and skilled nursing on one campus. Resident transitions between levels of care as needs change. Significant entry fees ($150k-$1M+) plus monthly fees.

See also: Assisted living

Specialized assisted living for residents with Alzheimer's or other dementias. Secure unit, dementia-trained staff, structured programming. Typically 25-40% premium over standard assisted living at the same property.

See also: Assisted living

Facility providing 24/7 medical oversight for residents who can't safely live in less-supervised settings. Two stay types: short-stay rehab (typically Medicare-covered) and long-stay (typically private-pay or Medicaid-covered).

See also: Assisted living, Medicaid LTC

Pennsylvania-specific category of group residence. Licensed under 55 Pa. Code Ch. 2600. Provides assisted-living-equivalent services in many cases but is a distinct PA license category.

See also: Assisted living

State agency investigating reports of abuse, neglect, or financial exploitation of vulnerable adults. Each state has a 24/7 reporting hotline. Investigation timelines and authorities vary, but every state has APS.

See also: Vulnerable adult

State laws (enacted in nearly all states) requiring hospitals to (1) ask the patient to designate a family caregiver, (2) notify that caregiver before discharge, and (3) train them on tasks they'll perform at home. Materially under-used.

Federal law providing 12 weeks of unpaid, job-protected leave per year to care for a parent with a serious health condition. Applies to employers with 50+ employees within 75 miles. Some states have paid family-leave programs that supplement FMLA (CA, NY, NJ, others; not FL/TX/AZ/PA).

See also: Paid Family Leave

Private professional (often a nurse or social worker) hired to coordinate complex elder care — especially useful for distance caregivers. Typical rate $100-200/hour; valuable when family lives far from the parent and a crisis is brewing.

State-level paid leave to care for a parent or family member. California PFL (up to 8 weeks paid at 60-70%) and New York PFL (12 weeks at 67%) are the largest among our six. Florida, Texas, Pennsylvania, and Arizona have no state PFL — FMLA only.

See also: FMLA

Short-term care provided so the primary family caregiver can take a break. Delivered through in-home aides, adult day programs, or short-stay residential placements. Most state AAAs offer respite vouchers or referrals.

See also: Adult day care

Arizona statutory category (A.R.S. §46-451) creating civil and criminal remedies for abuse, neglect, or exploitation. Distinctive feature: treble damages and attorney's fees available — one of the strongest elder-abuse civil remedies in the US.

See also: APS

Local agency designated under the federal Older Americans Act to coordinate services for adults 60+. There are over 600 AAAs nationally; each state divides into planning and service areas. The AAA is the right first call for most caregiving questions.

See also: ADRC

'No-wrong-door' single-entry point for long-term services and supports. Often co-located with or operated by the AAA. New York Connects is one of the more developed examples among the launch states.

See also: AAA