If Medicaid has a claim on the estate, the person who used Medicaid services and their spouse has been made aware of that. In some families they might choose not to share that info with the rest of the family.

Medicaid benefits were designed for the very needy. If the patient has significant assets, like a home, Medicaid allows them to get the needed care without having to sell their home to pay for care while they are still living in the home.

There are some protections in place to protect some assets for the spouse of the patient. My mom will probably need to go to a nursing home soon. That care averages $100,000 a year. My parents can pay for that for a short time, but certainly not for 20 years. When her free cash runs out, she will transfer to Medicaid to pay for the nursing home. Medicaid will not place a lien on the house, forcing my dad out, because the total value of the house is less than $800,000. That amount buys a pretty nice house around here. He has a friend from his caregivers support group who is dealing with a Medicaid lien on his house for his deceased wife's nursing home care because their house is worth $1.5 million. A spouse is also allowed to keep (in my state) $114,000 in cash of the shared assets.