Tuesday, November 18, 2014

Help Qualifying for Medicaid Long Term Care

Diversity of Medicaid Planning Assistance Options Can Confound Applicants

For those seeking long term care assistance from Medicaid, determining eligibility is challenging and the application process is daunting. Couple this with the fact the person completing the application paperwork is very often doing so on behalf of a loved one for whom they are concurrently providing care. This combination of challenges can make the process of obtaining Medicaid assistance almost insurmountable.

Fortunately, Medicaid planning assistance is available. Unfortunately, there is such a diversity of individuals and professionals who refer to themselves as Medicaid Planners that one more challenge exists for caregivers: determine which form of Medicaid planning assistance is right for your situation. Some planners provide services free of charge and others are fee-based. Some are public employees; others are employed by for-profit organizations. Some will refuse to provide assistance if the applicant's income or assets are too high and others will refuse if they're too low. To say it is confounding is an understatement.

It is not an exaggeration to say one needs assistance to determine the type of Medicaid planning assistance one needs. Here we provide that assistance—to direct persons seeking Medicaid planning assistance to the appropriate resource for their needs.

Getting Started

Photo by Nathan Pfau

Our organization has identified seven different categories of professionals who provide assistance helping families with the Medicaid application process. Start by considering which one of these groups best describes your financial situation:


Group 1

  1. Applicant's monthly income is less than $2,000 or $3,000 if married.
  2. Applicant's total financial assets, not including their home, are valued at less than $2,000

Group 2

  1. Applicant's monthly income is between $2,000 - $3,500. If married, joint income is greater than $3,000 but less than approximately $4,500.
  2. Applicant's total financial assets, not including their home, are valued between $2,000 and $50,000. If married, combined assets are valued at less than approximately $115,000.

Group 3

  1. Applicant's monthly income is greater than $3,500 or, if married, joint income is greater than $4,500.
  2. Applicant's total financial assets, not including their home, are valued at more than $50,000 or if married, combined assets are valued at less than $115,000.

Group 1

Applicants in Group 1, very likely, already meet their state's financial eligibility requirements for Medicaid long term care services. This means they will require no assistance qualifying or simply administrative assistance managing the Medicaid application paperwork. There are multiple sources from which they might gain help at no cost.

  • Area Agencies on Aging - there are a network of over 500 local area agencies on aging throughout the country. These agencies employ Case Managers / Benefits Counselors who help applicants to understand the Medicaid application process, gather the necessary documents and fill out the paperwork. Typically, each agency has responsibility for multiple counties.
  • County Medicaid Offices - Each county has an office responsible for managing Medicaid. Administrators may be available to help with the Medicaid application or they may refer you to the local area agency on aging.
  • SHIPs Counselors - These are volunteers who provide free counseling, usually over the phone, on Medicare and Medicaid benefits. They are perhaps better used to answer specific questions one might encounter while filling out the application, rather than guiding you through a Medicaid application process step by step.


Group 2

Applicants in Group 2 may already meet their state's Medicaid eligibility requirements, or they may qualify through a Medicaid Spend Down program or their assets and incomes may require some minor financial re-structuring in order to meet Medicaid limits. Because their status is uncertain, they may compromise their opportunity to qualify for Medicaid by seeking assistance from a state employed individual. Therefore, the prudent approach is to seek outside (non-public) assistance, even though they may have to spend money out of pocket to do so. It is worth mentioning that for most individuals the money they spend out-of-pocket on professional assistance is money they would have otherwise have been required to spend on care through a Spend Down program. There are multiple avenues of assistance available; each with pros & cons.

  • Geriatric Care Managers - Care managers are professionals hired to manage all aspects of caring for an aging loved one (except providing hands-on care). As such, most are familiar with Medicaid and the planning and application process. Care managers typically bill by the hour and could provide as much or as little assistance as is required for any applicant. Using a Care Manager for Medicaid application assistance is best suited for those families who also require care management assistance.
  • Eldercare Financial Planners - Financial planners specializing in eldercare can also be proficient in Medicaid planning. These professionals are best suited for those with broader financial planning goals which include but are not limited to qualifying for Medicaid.
  • Fee-Based Medicaid Planners - These are dedicated professionals who specialize in helping families gain approval for Medicaid long term care and nothing else. They bill a flat fee for their services and can be very efficient in their processes. These are best suited for families whose sole goal is to gain Medicaid approval.

Group 3

Applicants in Group 3 have both incomes and financial assets that are higher than Medicaid's limits. These individuals may not be able to afford their cost of care, especially on a long term basis, but they still do not qualify for Medicaid assistance. These candidates are typically hoping to prevent becoming impoverished in order to gain Medicaid benefits.

  • Elder Law Attorneys - Using a lawyer for Medicaid planning is probably the most expensive option but the expense is justified when a variety of complicated scenarios exists. For example, when the applicants are significantly over the limit and they have considerable assets they wish to protect or when a special needs trust is being set up for a family member. Another example is with married couples where only one spouse requires Medicaid and the other wishes to continue living independently.
  • Eldercare Financial Planners - Financial planners specializing in eldercare are also a good option especially when the financial planning needs extend beyond simply planning for Medicaid as is likely the case for families in Group 3 with higher net worths.
  • Commission-Based Medicaid Planners - Planners who work on commission are mentioned with a word of caution. These individuals make commissions from the sale of Medicaid compliant annuities and trusts and will usually only work with those with higher countable assets. They do not charge their clients. As such, their primary motivation is to sell financial products not to gain their client's access to Medicaid services. Their interests are not aligned with those of their clients. That said, they can still provide a valuable service but potential candidates must proactively look after their own interests.

Do you or your organization provide Medicaid planning services? Do you agree with our assessment? Have we missed any types of assistance providers? We welcome your comments.