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Medicaid Planning

Medicaid Programs and Planning Issues

There is no concise way to describe Medicaid planning.  Within Medicaid (called “MO HealthNet” in Missouri), there are a variety of different programs, and each has different criteria.  One constant is that an applicant’s resources must be below $999.99 on the date of application (for a single person).  But other variables, such as transfer penalties, income rules, and rules for spousal resources, vary between programs.  The rules can vary further based on whether the person is single or married.  Further, a person who is on Medicaid may be on other programs, such as HUD or Food Stamps, that have a completely different set of rules, and the rules of each must be considered when implementing a Medicaid plan.

The rules for the two main Medicaid programs our clients seek, Medical Assistance (often referred to as “Spenddown Medicaid”) and nursing home Medicaid (referred to as “Vendor Medicaid”), have different eligibility requirements and transfer rules.

A plan for qualification can be tailored for either program.  Some of the variables reviewed in creating a plan are:

  1. Whether the applicant has exempt assets (such as the first car, the home or an irrevocable preneed burial contract);
  2. Whether resources have been transferred in the past five years, and if so, to whom and whether those gifts can be recovered;
  3. Whether any assets have been sold for fair market value;
  4. Whether the applicant has any other debt;
  5. The assets of the client (and spouse, where applicable);
  6. The income of the applicant (and spouse, where applicable);
  7. The nature of the disability of the applicant;
  8. The level of care the applicant needs and will likely need in the future;
  9. Whether the applicant is married; and
  10. Whether the applicant has a disabled child or other disabled person in their life.

This list is a starting point, and not an exhaustive list. After gathering information, an analysis of the program requirements and planning options available to the client are considered and implemented.  Some of the planning options for reducing assets are simple, such as purchase of an exempt asset; others, of course, take some time to review and understand, and involve complicated estate planning.

As with VA benefits, Medicaid plan must look at the following:

  1. The affect of any transfers previously made;
  2. Other benefits available to the client and whether or not it is wise to plan for only Medicaid or concurrently plan for other possible benefits;
  3. Tax consequences to the planning (ie., is the opportunity to obtain a government benefit outweighed by the possible taxable outcome?);
  4. Whether the health of the client justifies extensive planning; and
  5. Protecting the healthier spouse, where applicable, to ensure the spouse has adequate resources and income to maintain their ability to remain at home.

Types of Services Offered:

  1. Long-term planning through estate planning techniques.
  2. Eligibility planning, including annuity purchase coordination and spend down advice.
  3. Medicaid Applications for individuals and couples.
  4. Division of Assets for married couples where one spouse is living in a skilled facility.
  5. Legal advice and issue resolution to maintain benefits where current Medicaid benefits are jeopardized or lost, appeals and benefit reinstatement.

Call us for an initial consultation, at (314) 932-5573, to discuss your options.  An in-home consultation or consultation at a facility can be arranged at no additional cost, if necessary.