What is "an estate that is spent down for Medicaid approval"? Are the rules different by state? Does a Medicare supplement help?

BELOW is a link to our attorney. She has lots of information on her website. Even though this applies to SC, it can show you why you need to contact an attorney for advice. Any attorney can help BUT only use an attorney who is experienced in Elder or Estate Law to get the best advice based on the latest changes in your state laws. This info can also help you come up with a list of questions to take to the attorney you select.
NOTE: The info on her website ONLY applies to laws in SOUTH CAROLINA… each state has their own variation of Medicaid laws.

https://www.strattonreynolds.com/blog/

If you are in SC, I highly recommend this firm.

Forgot to say, no Medicare and secondary insurances help with eventual care in an AL, MC or NH. They are heath insurances.
Medicaid does not usually help with the cost of an Assisted living or Memory care. Some States do with my State of NJ you pay at least 2 yrs privately and then u can apply for Medicaid so u can stay in the AL or MC.

To keep this all ready for your family a complete list of your assets, keeping all your checking records for at least five years back, making notations of any gifting you do, keeping records and keeping files. Also discussing with family and getting DPOA and will all written up. Letting everyone know where your accounts are and who the POD is on all accounts (and being certain there IS a POD).
Seeing a Trust and Estate Attorney for advise on how to organize and appoint. And congratulations on doing this. There are some in your family more either smart, organized, capable, dedicated, nearby, or whatever, and you will explain AHEAD OF TIME to ALL family why you chose this person for your POA for Health and to handle your advance directive. You will discuss your feelings about death and about end of life care.
I learned a lot of this by being a nurse. Seeing the shock and helplessness of family over and over again was a great teacher.

Try calling your Office of Aging and ask if someone can help you in planning for your life ahead.

You should get your POAs in order for financial and Medical. Assign someone you fully trust and will consider your wishes when making decisions for you when you no longer can. This person needs to be living close by. You need a Will. This should be updated as things change. We changed ours when the kids became adults. If one of us passes, the spouse living should make a new one. Make sure all your paperwork is in order and where it can be found easily. Don't keep old bills and paperwork. Keep 5 years of bankstatements for Medicaid look back if needed. My Mom made my life so easy because she had done this.

You don't need to spend down assets now unless you feel you are going to need Medicaid for NH or in home care within the next 5 years. What you want to do is protect what you have. Put your home in a trust. Set up other assets this way. As suggested, see an elder lawyer to help you set things up.

Singing, good to see you.

I recommend having a CELA help you get everything set up. This is what we have done. There is no guessing or crisis mode when the time comes. We found that a CELA was cheaper because they are certified elder law attorneys and we weren't paying for them to sort it out, it is also a comfort knowing they care enough to ensure they got it right for you. They will notify us if any laws change that affect our plans and things need modifying to stay legal and enforceable.

Our EOL paperwork lays out the steps for our care, possessions, our desires and wishes, right down to what music to play with music therapy, etc. It is the kindest gift we could give to family and ourselves.

You are awesome to want to get your affairs in order to make things easier, for everyone involved.

If you click on "Care Topics" at the top of the page, you can scroll to "Paying for Care".

You should probably read through some of the articles, especially those by Gabriel Heiser, to get a sense of what is meant by "spend down".

Medicaid is a State/Federal partnership, and each state is unique in its requirements. Most have a 5 year "lookback", meaning that you will need to have access to and be able to submit 5 years of bank/brokerage/pension statements in order to make an application.

There are certified Eldercare attorneys and Medicaid planners in your state who can help you make sense of this all.