Can Medicaid place lien on home owned solely by spouse?

So long as your mother outlives her husband, the house is protected and the state cannot come after it for recoupment of Medicaid payouts on his behalf. However, regardless of the pre-nup (ignored by law for Medicaid purposes), if she happens to pre-decease him, he is entitled to his spousal share per state law (varies per state, but typically 1/2 to 1/3 of all her assets). If her will bypasses him, he is treated by Medicaid as if he received the property and then gifted it to the actual recipients. That would cause him to lose his Medicaid.

Medicaid in Virginia caps a home value at $552,000 so I think you are safe from that standpoint. On the other hand, there are other asset caps for the community spouse, which you need to discuss with the benefits coordinator. You look at the whole financial picture.
Medicaid will NEVER take her house away from her! She can stay there for the rest of her life, if that is possible!

TammySB: The home is titled in HER name, e.g. you state "25 years it has been in her name only." For Medicaid purposes, therefore, her home is classified as a non countable asset.

We went through the planning for this, never got to that point as my stepdad passed before his funds were spent. Mom and he married ten years ago, she has Alzheimer's and may spend all of her funds on her care. Stepdad had general age related decline. If he had lived to spend his funds mom would have been responsible for contributing to his nursing home cost until her funds were spent. Medicaid does not consider prenups when seeking recovery. Prenups are valid only for a divorce.

But, there is planning that can be done through an elder law attorney that specializes in Medicaid planning. I suggest you see one asap. Medicaid does not want to impoverish a spouse so that mom is not able to pay for her care.

No, not if it's not in his name. They can't take something belonging to someone else belongs to someone else. As long as the patients name is not on the asset, no one can put a lien against it

See an elder law attorney that specializes in Medicaid planning. That is the best route as the attorney will know all the rules and regulations in mom's state and how to best protect her assets from stepdad's medical expenses.

Unfortunately when you say "I do" it also means "I give" as far as the state is concerned. Good news is Medicaid won't do a thing. Community spouse, exemptions are in place. Estate recovery after he passes MAY attempt to recoup some tho. Like someone else says, it's best to consult an attorney to be prepared for what can come and how to best prepare. Don't ask the Medicaid folks even tho some will attempt to answer. I am one and we do not know what estate recovery is/can do other than that when we discussed them in training we concluded they were heartless.

Every state is different. I know a widow remarried. Her will stated that if she passed before her new husband he was allowed to live in the house. Upon his death, the house reverted back to her children. Which is what happen. He passed before a NH was needed.