It depends on the state. Some states don’t exempt IRAs even when they are in payout status, so the IRA will have to be spent down before qualifying for Medicaid benefits. But for those states that exempt IRAs, the question is whether the state’s estate recovery rules permit it to go after non-probate property. IRAs usually have named beneficiaries and, as a result, don’t go through probate, so they would only be subject to estate recovery claim if your state has expanded Medicaid estate recovery. A local elder law attorney can provide the specific answer for your state.