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It’s a numbers dance... you have required actuarial tables that must be met in order for SPIA to be done in order for it be to Medicaid compliant. Don’t ask me what they are as it’s all set by your demographics. It’s unique. And you can do more than 1 SPIA.
There’s someone on this site who did one several years ago as his wife was early onset dementia. She just recently passed away. I’ll PM him to see if he can post.
The one I know was may/dec with younger second family & her hubs almost 70 had major auto crash. Brain trauma with months of speciality rehab. He went through his insurance lifetime cap & savings in around a yr. she had to get/ force his kids from M#1 to sell weekend camp that she had usafruct on to have $ for his care as rehab took no Medicare or Medicaid. It was major drama atop his deteriorating health. What I heard was that it was she was beyond stressed & asked about divorcing him & it was the divorce atty that mentioned spia & put her with NAELA atty . They have kids in middle & high school plus she didn’t work (so no income). She ended up taking their college $ to do 2 SPIAs - bigger one paying more income while kids still under 21 or 25? then running dry & the other smaller another decade past the first till it too runs out. She’s more than likely going to outlive both SPIA. It won’t matter if Medicaid is the designated beneficiary as the $$ will be paid out with zero balance annuity before she dies. There’s planning, taxes & contingencies in doing these that have to be looked at by experienced eyes. Not a diy. Again it’s specialty underwriting. Not the guy who has an insurance license and sell homeowners or auto insurance.
Oh they didn’t divorce. She was able to get him onto Medicaid & moved to the only good rehab place that can do LTC brain injury that takes Medicaid. He lived about another yr. was on Medicare & Medicaid; heard everybody was all kum-ba-ya at the end.
As an aside on this, apparently in high cotton divorces, atty gets the monied one to do a big SPIA if alimony not a part of divorce settlements or there’s a hard to budge prenup. Clever! Gawd I just love savvy legal.
https://www.elderlawanswers.com/annuities-and-medicaid-planning-12008
One thing I don't like about it, according to the link above, is that upon my death, the state is my beneficiary.