Medicaid: It’s a Process

Failing to plan is planning to fail. Perhaps Benjamin Franklin was speaking about Medicaid Planning when he first turned this phrase. It certainly applies.

As much as seniors want to “age in place,” few have executed estate planning documents that contribute to the success of that plan. Family members find themselves without the authority to make decisions on behalf of their loved ones. This can include the ability to apply for public benefits. And, in most cases, when a crisis comes, they need Medicaid, and they need it yesterday.


3 Primary Medicaid Programs

Institutionalized Care Program (nursing homes)

Statewide Managed Medicaid (home and community)

Qualified Medicare Beneficiary (QMB)

No need to get overwhelmed about which benefits you need and how to apply. A knowledgeable Elder Law Attorney can help you determine which benefits are best for your situation. Need Medicaid benefits that help pay for assisted living or a nursing home? A public benefits attorney can walk you through the steps of Medicaid Planning – or Medicaid crisis. It’s your choice.

The Cost of Care is Steadily Increasing

Many times, the need for Medicaid comes on the heels of – or amid – a crisis. An older loved one has experienced a medical event and requires hospitalization, followed by a stay in the local rehab center (also called a nursing home). Once Medicare benefits and secondary insurance run out – who pays?

You do. And a lot. Paying privately for a nursing home can cost an average of $8,364 for a private room and $7,441 for a shared room per month. 80% of older Americans cannot afford two years in a nursing home. Even though Plan A is to stay healthy forever, it’s a good idea to have a backup plan. However, Medicaid planning takes time.

Timeline for Medicaid Planning

  1. Consultation
  2. Application
  3. Approval

Seems easy – just three steps? Well, yes and no. Mostly no. There can be multiple steps within each step that can be different for each person. Need Medicaid in a hurry? Be prepared to provide all the information they need as quickly as you can.

1. The best time for a consultation is before you need public benefits.

If you have concerns about a loved one needing public benefits to pay for health care in the future, schedule a consultation for Medicaid planning now. You will need time to gather the information needed to provide a full picture of your income, assets, and expenses for the Medicaid planning attorney. Every situation has different facts which lead to different strategies and paths.

It is helpful to know what to expect. During the consultation, the public benefits attorney can provide insight into what is involved in the process, including a checklist of all documents you are required to provide. Planning ahead makes a difference – who has time to do this in a crisis?  After your consultation, if it is determined that you or your loved one need Medicaid now, then you will need to retain the attorney to represent you. Therefore, they can move forward, guiding you on eligibility and submitting the application.


2. The application relies on the information you provide.

If you provide all the information needed quickly, the application process can be completed in a timely manner. If you are slow in supplying the documents needed to assess your income, assets, and medical expenses, your application will be delayed. Your attorney will provide the full list of documents needed. This will include photo IDs (that aren’t expired), bank statements, life insurance, death benefits, proof of income, and for Veterans or their spouses, a DD214, among others.

Possible Roadblock: No Power of Attorney

A power of attorney is a legal document that assigns an agent to be able to act on your behalf with regard to your finances. If a power of attorney has not been executed by the individual applying for benefits, they must be assessed for capacity. If they are deemed to have capacity and therefore can sign documents, a power of attorney should be drafted. Then, it can be delivered to the individual for review and signature. For proper execution of the power of attorney, this may require up to three people from the attorney’s office to travel to the client’s bedside which can take time to coordinate.

For an individual experiencing a health crisis, participating in their own public benefits application is not reasonable, so a power of attorney must be executed naming an agent.  A key advantage of Medicaid planning before a crisis is getting the power of attorney in place. That way, your agent can step up and act when needed. Without the proper authority in place, the attorney’s office is unable to communicate with financial and medical institutions to verify the income, assets, and expenses you’ve provided.

3. Approval does not come quickly.

Even an application that appears straightforward can come with its own set of challenges. The public benefits attorney and their team of Medicaid specialists are constantly communicating and collecting information to support the Medicaid application. Each application goes through the Medicaid screening process to determine eligibility.

Your Medicaid Planning attorney is invaluable during the entire process. Each step towards completion is verified and the application is submitted with the best possible chance of approval. Additionally, the specialists and attorneys are well-versed in the Medicaid process and will communicate with you throughout.

After Medicaid Approval

For a nursing home/ICP client, Medicaid will pay the balance of the patient’s bill after their “patient share of cost” is paid (all their income minus $160 for incidentals). For an individual living at home or in an assisted living facility at the time of approval, Medicaid will send you a welcome letter and provide you with information on how to choose your health plan. This will include information on the plans that are available in your area as well as the phone number to contact a Choice Counselor.


Medicaid Planning is an empowering process that puts you in charge of your future. Working with an Elder Law Attorney with a depth of knowledge in public benefits ensures that, should your Plan A to stay healthy forever hit a bump in the road, you can still obtain the benefits you need to preserve your legacy and protect your family.

The knowledge to help you plan or walk you through a crisis are two reasons why Elder Law Attorneys are Resources We Love. Learn more about how estate planning can help you avoid a Medicaid crisis in the Legal and Financial Section of our Blog.

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