Medicaid applicants can have only a small amount of assets in order to be eligible to receive benefits ($2,000 in Louisiana). Certain assets — i.e., a house, car, and burial plot — are exempt from eligibility determinations. Whether your IRA counts as an exempt asset depends on whether it is in “payout status” or not.
At age 72 (or if you turned 70 ½ in 2019 or before), individuals must begin taking required minimum distributions from their IRAs, which means the IRA is in payout status. You may also be able to choose to put your IRA in payout status as young as age 59 ½ if you elect to take regular, periodic distributions based on life expectancy tables. If an IRA is in payout status, in Louisiana, it does count as an available asset for the purposes of Medicaid eligibility, and the payments you receive will count as income. Medicaid recipients are allowed to keep a tiny amount of income for personal use and the rest will go to the nursing home.
If the IRA is not in payout status, the IRA is a non-exempt asset, which means the total amount in the IRA will probably be counted as an asset, affecting your Medicaid eligibility. In order to qualify for Medicaid, you will need to cash out your IRA and spend down the assets. Alternatively, you could transfer the money to your spouse or someone else, although there will likely be an income tax penalty for doing this. (Roth IRAs have no required minimum distributions and cannot be put in payout status, but they are usually counted as assets.)
The rules for a 401(k) are similar to an IRA. If the 401(k) is not in payout status, Medicaid may count as an asset any funds you are eligible to withdraw from the 401(k)–even if you have to pay a tax penalty to withdraw the funds.
Note that the rules for a Roth IRA may be different. If you have a Roth IRA, depending on the rules in your state, it may not be exempt at all because Roth IRAs do not require minimum distributions.
The rules regarding IRAs and Medicaid are complicated and vary from state to state. You should talk to your attorney about your IRA to determine the best course of action for you.