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Medicaid Consultation Tips

Medicaid Consultation

Let’s dive into what you can expect from a consultation with a Medicaid planner or elder law attorney and how to narrow down your search.

What to Expect During the Consultation:

  1. Overview of Your Situation:
    • You’ll likely begin by discussing your financial and healthcare situation. Be prepared to share details such as:
      • Your assets (bank accounts, real estate, investments, etc.).
      • Your income (pensions, Social Security, other sources).
      • Any existing healthcare needs or plans for long-term care.
      • Whether you have a spouse or dependents who might be involved in planning.
  2. Explanation of Medicaid Eligibility:
    • The attorney or planner will explain the specific Medicaid eligibility rules for your state, including:
      • Asset limits: What assets Medicaid will count and exclude.
      • Income limits: How your income is treated for Medicaid purposes.
      • Look-back period: How the 5-year look-back applies to asset transfers and potential penalties.
  3. Available Strategies:
    • Based on your specific situation, the professional will propose asset protection strategies. These could include:
      • Spending down excess assets on allowed items (e.g., home improvements, medical costs).
      • Irrevocable trust planning to protect assets while qualifying for Medicaid.
      • Medicaid-compliant annuities to convert assets into income.
      • Gifting strategies that minimize penalties (if they can be safely done without triggering Medicaid’s look-back period).
  4. Risks and Benefits:
    • They should outline the potential risks (such as penalties for improper asset transfers) and benefits (such as preserving assets for heirs) of each strategy.
    • The planner should be clear on whether a strategy will reduce Medicaid eligibility or protect assets for you or your family.
  5. Costs and Fees:
    • Be sure to ask about fees. Some Medicaid planners charge a flat fee for a full planning package, while others charge an hourly rate. Elder law attorneys may have hourly rates or charge for specific services.
    • Cost of services can vary widely depending on the complexity of your case and where you live.
  6. Timeline and Next Steps:
    • The attorney or planner should give you a clear timeline for completing your Medicaid planning. If you’re considering transferring assets or setting up trusts, the process may take time.
    • They should also explain when to start the process in relation to when you plan to apply for Medicaid benefits (the earlier the better to avoid penalties).

Tips to Narrow Down Your Search:

To make sure you find the best Medicaid planner or elder law attorney for your needs, here’s how to refine your search:

  1. Look for Specialization:
    • Ensure the attorney or planner specializes in Medicaid planning and elder law. Medicaid rules are complex, and specialists will know the intricacies of the system in your state.
    • Use NAELA or other trusted directories to search for professionals who explicitly list Medicaid planning as their specialty.
  2. Local Experts:
    • State-Specific Knowledge: Since Medicaid rules vary by state, it’s vital to find someone familiar with your state’s laws. Look for attorneys or planners who advertise that they focus on Medicaid planning within your state.
    • Community Connections: Local Area Agencies on Aging (AAA) or senior centers might have recommendations for attorneys who have a strong reputation in your area.
  3. Check Reviews and Testimonials:
    • Client Testimonials: Check online reviews and ask for references or testimonials from past clients. Look for someone with experience handling cases similar to yours.
    • Referrals from Trusted Sources: Reach out to your local senior community centers or even financial advisors for recommendations.
  4. Evaluate Their Approach:
    • Comprehensive Services: Ideally, you want someone who offers comprehensive services, not just help with Medicaid eligibility, but also long-term care planning, trusts, and other related services.
    • Personalized Guidance: Ensure the planner or attorney is ready to provide tailored advice that considers your specific circumstances rather than offering a one-size-fits-all solution.

Sample Questions for the Consultation:

Here are some specific questions to ask during the consultation to gauge their expertise and approach:

  1. How much experience do you have in Medicaid planning?
    • Look for someone with extensive experience in both the legal aspects and strategic planning necessary for Medicaid eligibility.
  2. What is your approach to asset protection?
    • You want to ensure they offer practical and effective strategies, not just basic information on eligibility.
  3. What are your fees? How are they structured?
    • Understand whether the attorney charges an hourly rate or a flat fee, and get a clear idea of the total cost for planning.
  4. How do you handle Medicaid’s 5-year look-back period?
    • Ask how they would approach a situation involving transfers or asset protection within the 5-year window.
  5. Can you explain the potential risks of different Medicaid planning strategies?
    • A good planner will openly discuss the risks of various strategies, such as asset transfers or using trusts.
  6. What is the timeline for completing my Medicaid planning?
    • If you need to qualify for Medicaid soon, ensure the timeline works with your goals. Medicaid planning can sometimes take several months.

Final Decision:

After meeting with a few professionals, consider the following to make your decision:

  • Comfort level: Do you feel comfortable with the professional? Can they explain things in a way that you understand?
  • Expertise: Does the attorney/planner have a track record of success in Medicaid planning, and are they well-versed in your state’s rules?
  • Value: Are the fees reasonable for the level of service they offer? Do you feel they will help you protect your assets while meeting your Medicaid eligibility needs?

For more information, go to:  www.seniorhousingsolutions.net

How do you pay for Assisted Living?

How do you pay for Assisted Living?

As senior housing advisors, we speak with many clients who need assisted living and not sure how to pay for it. There are some resources that you may be unaware.

Medicare?

Medicare will only pay for care in Medicare-certified skilled nursing facility or through Medicare-certified home health or hospice agencies. It will never pay for care in an assisted living facility.

Medicaid? 

The Medicaid Waiver Program is available throughout the state of Florida, however interested applicants should be aware that unlike other Medicaid programs, this is not an entitlement. One may meet all the eligibility requirements only to find that there are no available rooms and they are put on a waiting list for services.  It is important to note that not all assisted living facilities accept the Medicaid Waiver Program and it might be necessary to move out of the area to find a facility that accepts it. Typically, the Medicaid Waiver Program only pays for a portion of your rent and does not pay for care-related charges. One should contact their local Area Agency on Aging to learn more and determine if a wait list exists in their geographic area.

Other state programs? 

One program is called PACE (Program of All-Inclusive Care for the Elderly).

If you qualify, PACE will cover all the medical, social and rehabilitative services you need, including items that Medicare does not cover, such as social work services, meals and nursing home care. You will receive all your health care (Medicare and Medicaid benefits) through the PACE program.

There are eligibility requirements of the PACE program as well as stipulations that you must agree to qualify. Like the Medicaid Waiver program, only a limited number of assisted living facilities in our area accepts PACE. In addition, PACE is a state funded program with limited resources, therefore there are times when PACE stops accepting new candidates. For more information, contact the Florida Department of Elder Affairs.

Veteran’s Administration (VA)?

The Aid and Attendance Benefit offered through the Veteran’s Administration is not a well-known benefit, yet it could be one of the most important benefits you could receive.  This program was established for eligible Veterans and their Spouses to help pay for assisted living, skilled nursing and home health care. The Veteran or Spouse qualifies for this benefit if their service, medical qualifications and financial criteria are met.

To medically qualify, you would need assistance with two or more “activities of daily living’ (ADLs).  These would include:

  • Medication management
  • Bathing or hygienic tasks
  • Meal management
  • Transferring
  • Mobility
  • Dressing
  • Continence

The Veteran must have service one day of active duty during a wartime period and was honorably discharged.  Spouses who have been divorced are not eligible.

Based on your income, the Aid and Attendance program could pay:

2017 Maximum Monthly Benefits:

Veteran with Spouse:  $2,127

Single Veteran:            $1,794

Surviving Spouse:       $1,153

Dependent Spouse:     $1,408

This program pays the Veteran or Spouse and not the assisted living facility, therefore it is applicable at all assisted living facilities.

For more information, contact the Veteran’s Administration. 

Long term care insurance?

If you have a long-term care insurance policy, you should review your policy to determine what it covers and what it doesn’t. Every policy is different. Many policies have an elimination period, typically 90 days and have specific guidelines about which type of facility they will reimburse.

Usually, the long-term care insurance carrier pays you the benefit; therefore, providing the assisted living facility meets the criteria for reimbursement, you would be paid the benefit amount, not the facility.

Private pay?

The most common way to pay for assisted living is out of pocket.  People use their own investments or the proceeds of the sale of their residence. Family members also contribute. It is wise to speak to your financial advisor BEFORE you need assisted living and develop a plan for your future health care needs. These might include annuities, trusts, reverse mortgages and other investment strategies.

Meals, housekeeping, home maintenance, transportation, social activities, utilities, cable, taxes and care are typically included in your rent, therefore your overhead expenses are many times less than what you are paying at home.

We are here to help.

Senior Housing Solutions is familiar with all the assisted living facilities in our area and can help find a ‘solution’ for you. Our services are 100% free! We are not financial advisors, therefore cannot provide financial advice. We recommend resources to help you every step of the way.  For more information, please call (239)595-0207 or visit our website at: www.seniorhousingsolutions.net.