You can transfer $12 million with no gift tax, so if you want to pass something down instead of reserving it for end of life care, it's no problem.

https://www.schwab.com/learn/story/estate-tax-and-lifetime-g...

Obviously that's more beneficial to people with a lot of assets than to someone with less, but for instance, a parent might choose to gift the house they live in to their children well prior to end of life care being a consideration (of course that will be very situational; do they want to stay in that house, do they have a good relationship, etc., etc.).

Medicaid won't consider the primary residence when examining assets to pay for care, but it may try to capture some of the estate after death.

In most states you have to transfer any asset or cash many years before you need state paid end of life care, otherwise they will charge you a "penalty" for basically the value of whatever you transferred, or deny you outright. So you basically have to accurately predict when you will need a few months of state paid end of life care (more like a room to die in for $6000 a month) years in advance.