Medicaid Planning

Advance preparation is the best action to help protect one's assets, while still being able to qualify for Medicaid when the need arises.

The basic premise of Medicaid planning is to move countable or unprotected assets into non countable or protected assets to legally shift the burden for the cost of the patients care onto the government. Additionally, Medicaid planning attempts to ensure transfers of assets to heirs, fully protect a healthy community spouse, and avoid or limit Estate Recovery. There are two primary Medicaid programs:

Medicaid Long Term Care - Medicaid LTC is a Public-Private partnership, with rules to balance the cost of care between the patient and the State. Medicaid LTC is a broad category that includes a variety of services for chronic and disabling conditions including care for health and daily-living provided by nursing home facilities and at home. Medicaid LTC planning is not limited to poor and low-income individuals and for most, planning is needed to qualify for Medicaid LTC benefits. Medicaid LTC planning falls into one of two categories:

• Pre-Planning. Pre-Planning is planning in advance for the eventual need of long term care services and pre-positioning assets or making intentional choices that will limit the overall exposure of assets and income to the costs of long term-care sometime in the future. There is typically a larger selection of planning options available for pre-planning. Unexpected circumstances can be planned for but the individual’s health and ability to satisfy the 60-month look back period could impact pre-planning efforts.

• Crisis Planning. Crisis planning occurs when there is an imminent need for LTC services and eligibility needs to be established to avoid paying full cost for LTC services. There are fewer planning choices available with crisis planning.

Medical Assistance - This is often referred to as health insurance for low income and medically needy individuals. To qualify, income and assets must be below established thresholds and the individual must meet the Aged, Blind, and/or Disabled Social Security definitions. Planning in this area usually involves moving excess countable resources into non countable positions.

In addition to these 2 primary areas, most Medicaid programs offer Waiver or Home and Community Based Services (HCBS). These programs are designed to help keep people in their homes and communities and most include extra benefits that include home modifications. Eligibility for Medicare PACE (Program of All-inclusive Care for the Elderly) Programs falls under these additional programs. These programs can be applied for at the same time and in conjunction with the initial Medicaid application.

Medicaid planning does not begin and end with gaining eligibility for benefits. Here are some of the areas of the Medicaid planning process where we can help:

• Retitling of assets transferred to the Community Spouse
• Medicaid LTC Pre-planning for Community Spouse
• Annual Redeterminations
• Review of all notifications and communications from the Assistance office
• Appeals relating to patient liability amounts which also includes the spousal allowance and other deductions   
• Reporting and spend down of “After Acquired” assets
• POA’s and Wills should be reviewed and updated if needed. Named Agents should be familiar with the components of the Medicaid plan should there be a need for them to act.
• Heir advocacy post death

Medicare Solutions

Medigap/Medicare Supplement Insurance

Medigap/Medicare Supplement insurance is sold by private insurance companies and is designed to work with Original Medicare (Parts A and B) to “fill” the gaps to cover all, or a portion, of the Original Medicare cost-sharing (coinsurance, copayments, and or deductibles). These plans do not cover Medicare benefits, they work in tandem with Original Medicare, but some plans cover benefits not covered by Original Medicare (ex. extra days of coverage for inpatient hospital care).

Medicare Advantage (MA) Plans – Part C

MA plans are sold by private companies. MA plans are designed to cover ALL Medicare Part A and Part B benefits, most also provide Part D prescriptions drug benefits (MA-PD) and extra benefits not covered by Medicare. Extra benefits can include routine dental services, vision services, transportation services for medical appointments, hearing aids, and other benefits. All MA plans have a maximum out of pocket limit. 

There are different types of MA plans to choose from that include Coordinated Care plans such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs). Other types include Private Fee For Service (PFFS) plans and Medical Savings Account (MSA) plans.

Individuals who are receiving both Medicare and Medicaid benefits are eligible to enroll in MA Dual Special Needs Plans (D-SNP) that are designed to coordinate the Medicare and Medicaid benefits, provide Part D coverage, and offer extra benefits as well.