With the passage of the Deficit Reduction Act of 2005, 42 U.S.C. §1396p, (DRA) the federal government sought to severely restrict Medicaid eligibility by radically changing the transfer of asset rules.

More particularly, the law was aimed at eliminating altogether transfer of asset strategies at the so-called “crisis” phase, that is, last-minute transfers of assets just prior to or immediately after placement in a long-term care facility. However, the federal law left open one planning strategy in particular—planning via a promissory note.