Can Medicaid Planning Assistance Improve Your Approval Odds?

Medicaid is a government-funded health care program that provides coverage to 68.8 million Americans with limited income or resources. Because the program is administered by each state and its financial requirements are complex and stringent, many potential applicants seek Medicaid planning assistance before applying. Learn what a Medicaid planner does and how planning can help you improve your odds of receiving benefits.

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Who Is Eligible for Medicaid?

Although specific eligibility requirements vary by state, Medicaid is typically available to people with limited income or resources, and those who need long-term residential care. Beneficiaries may fall into the following categories:

• Low-income adults and children
• Pregnant women
• People with disabilities
• Anyone receiving Supplemental Security Income (SSI)
• Young adults exiting the foster care system
• Seniors aged 65 and older
• Medically needy individuals

States may also opt to provide Medicaid coverage for other groups, such as individuals receiving community-based services.

Potential Medicaid beneficiaries typically must meet the following eligibility requirements:

• Fall within established income limits. Certain groups, including disabled individuals and seniors over the age of 65 may be exempt from this requirement.
• U.S. citizenship or lawful permanent residency
• Residency in the state of application

You should refer to your state's specific Medicaid guidelines to determine if you must meet any additional eligibility requirements.

How Much Can I Make to Still Get Medicaid?

In most states, single applicants are allowed to have up to $2,000 in cash and other liquid assets such as CDs, stocks and bonds. If a couple is married and both spouses are applying for Medicaid, the maximum allowed asset limits vary widely by state. 

What Can You Own and Still Qualify for Medicaid?

Although eligibility requirements vary based on your state of residence, the government considers certain possessions to be non-countable or exempt, up to a predetermined amount. Medicaid applicants may own the following items and still qualify for Medicaid:

• A primary residence in the state where the application is being submitted. If the applicant is in a residential long-term care program, their residence is considered exempt if their spouse or dependent child lives there or if the applicant intends to return home. Some states set maximum limits for the equity value of an exempt residence.
• Furnishings in the primary residence
• A car that is being used to transport the applicant or other household members
• Funeral and burial plans
• Life insurance policies

What Is Medicaid's Look-Back Period?

Medicaid's look-back period was designed to prevent applicants who require long-term care from gifting possessions or selling them below fair market value to meet the program's asset limit. Because funds generated from these items could potentially pay for care services, Medicaid reviews all asset transfers during the designated look-back period, and may issue penalties for violations. Violations may include significant donations to charity or transfers of property to relatives.

In most states, Medicaid's look-back period spans 60 months. The exception is California, which has a 30-month timeframe.

What Happens if I Get Denied for Medicaid?

If you're denied benefits through Medicaid, you have the right to appeal. Applicants must receive a fair hearing, and appeals procedures may vary by state. Free public assistance and hired Medicaid planners are available to help individuals who may not currently qualify for Medicaid benefits prepare the proper documentation and structure their finances and assets to improve their odds of acceptance in the future.

What Is Medicaid Planning Assistance?

Medicaid planning assistance is a process that helps prospective applicants improve their odds of acceptance by guiding them through the program’s complex eligibility requirements, helping them structure their financial resources and gather the necessary documentation. Medicaid planning assistance is available to individuals who are preparing to apply or reapply for benefits.

Medicaid planning assistance may be provided by the following professionals:

• Geriatric care managers
• Elder law attorneys
• Eldercare financial planners
• Case managers
• Public benefits counselors
• Insurance agents
• State health insurance program counselors
• Commission-based Medicaid planners
• Long-term care ombudsmen

What Does a Medicaid Planner Do?

A Medicaid planner’s job is to ensure their client has the best possible outcome when applying for benefits. To accomplish this, they help clients understand the complexities of eligibility requirements, prepare for the look-back period and navigate the application process. Medicaid planners may also help clients protect their family home and other assets for future inheritance, so non-applicant spouses may continue to live independently if their partner is receiving long-term care. 

Medicaid planners may help clients take the following actions:

• Create trusts, including irrevocable funeral trusts and asset protection trusts
• Convert countable assets into Medicaid-exempt assets
• Plan income spend-down strategies
• Execute spousal income transfers
• Create Lady Bird deeds
• Initiate Medicaid divorces

Medicaid planning assistance is available through a variety of sources, and costs may vary from nothing to several thousand dollars. Each type of Medicaid planner brings a different level and scope of experience, and not every advisor is qualified to help in all situations.

Who Can Benefit from Medicaid Planning?

Whether you may benefit from Medicaid planning assistance depends on a multitude of financial, personal and familial circumstances. Although anyone can hire a Medicaid planner, the following applicants may find formal planning assistance helpful:

• Married couples, where only one spouse is planning to apply for Medicaid
• Married couples who both require long-term care
• Families who wish to preserve assets for future generations
• Individuals or married couples with complicated financial situations

Are There Alternatives to Medicaid Planning?

Yes. For general Medicaid questions, free assistance is available directly from the government via phone or web chat.  State-specific Medicaid agencies are also available to answer questions about your state's guidelines and eligibility requirements.  

Self-planning is another option for potential beneficiaries. Options such as irrevocable funeral trusts are simple ways for potential applicants to prepare financially for end-of-life expenses while transforming financial resources into Medicaid-exempt assets.

What Is Medicaid Estate Planning?

As part of the aging process, some seniors require long-term residential care, which is typically paid for by Medicaid. Medicaid estate planning is a process designed to help prospective applicants meet program guidelines while legally protecting their assets for future inheritance in the event they require long-term care. If estate planning is executed well before the need for long-term care arises, assets may be successfully protected.

Medicaid estate planning may be offered through Medicaid planners, eldercare financial planners or estate planning attorneys. Through Medicaid asset protection trusts, gifting strategies and other techniques, Medicaid estate planners can potentially save beneficiaries thousands of dollars.

Where Can I Find Medicaid Planning Assistance?

The American Council on Aging provides a free online tool to help older adults find affordable Medicaid planning assistance.  Seniors may also visit Medicaid.gov to find contact information for state-specific Medicaid agencies.