According to a U.S. District Court, a promissory note that complies with federal law and received in exchange for other property is NOT a resource or a trust-like device and does NOT subject a Medicaid applicant to a transfer penalty.
In other words, if a Medicaid applicant transfers property in exchange for such a promissory note, then such a transfer would not be treated as a "disqualifying gift" under Medicaid law.
The case is Lemmons v. Lake, U.S. Dist. Ct., W.D. Okla., No. CIV-12-1075-C, March 21, 2013.