Table of Contents
There are many different types of professionals and volunteers that offer assistance to families to help them qualify for Medicaid. Not every type of advisor is appropriate for every situation, and some individuals offering advice may not always have the family’s best interests in mind. In addition, Medicaid planning can be difficult because while Medicaid is a Federal program, it is administered on a state level, and the regulations and rules (such as eligibility) that govern it can vary greatly by state. Even within a state, Medicaid laws and programs may regularly change. To assist one in finding the assistance that best fits their given situation, read through the pros and cons of each type of advisor below, and look at the comparison table for quick reference. One can also use our free locator tool to find the best option for your needs.
Types of Medicaid Planners
Elder Law Attorneys
Elder law attorneys are very knowledgeable about the Medicaid eligibility laws in the specific states in which they are licensed to practice law. Attorneys are also empowered to establish any necessary trusts on behalf of their clients. (Trusts may be used to restructure one’s assets in order to meet Medicaid’s financial eligibility requirements). This makes attorneys a complete solution for Medicaid planning. As their clients pay them directly, typically on an hourly basis, one can be confident that the attorney is advising them in their best interest. On the downside, hiring an attorney is, far and away, the most expensive Medicaid planning option. Depending on state, fees can range from $300 – $600 per hour. The cost of an engagement might range from $3,000 on the low end to as high as $10,000.
Geriatric care managers (GCMs), also referred to as eldercare managers, senior health care managers or life care managers, typically provide a broad range of services to their clients, such as care planning, assessments, and care coordination. It is estimated that approximately 25% of care managers also provide assistance with planning on the financial side of eldercare. They tend to have more practical experience and less formal training with financial planning and legal matters. One major benefit is that typically care managers are very knowledgeable about local programs that provide assistance as alternatives to Medicaid. Since their primary expertise is care management, and hence, a client-centered approach, they are well aware of the individual’s care needs. As they work with a family for broader purposes, there exists a relationship based on trust, which makes it more comfortable to share financial information. Finally, as one pays a care manager directly, one can be confident they are advising in their client’s best interest. On the downside, while not as expensive as attorneys, one is still paying for a care manager out-of-pocket. They also cannot perform legal work on their client’s behalf, as do attorneys. Nor do they have broader financial planning experience, as most care managers tend to come from a nursing or social work background.
The major positive aspect of working with an eldercare financial planner who is focused on eldercare is that they have a very broad understanding of all the financial options available to the individual. Financial planners are a good option when there exists a variety of choices for funding, such as life insurance settlements and reverse mortgages. Financial planners are experts at building a plan that addresses the long term nature of long term care. As with attorneys and care managers, one pays them directly. Therefore, one can be confident they are receiving consul in their best interest and there is no conflict of interest. However, like attorneys, they are expensive, and while their knowledge of financial matters is broad, they are often less well informed about local programs that provide financial or care assistance, which can be alternatives to Medicaid. They are also less knowledgeable about the care requirements of their clients than geriatric care managers. For example, a Care Manager will have a thorough understanding of the care progression someone with Alzheimer’s Disease will go through and the financial impact, while a financial planner might not have the same awareness.
Public Benefits Counselors / Case Managers work for state agencies at Area Agencies on Aging (AAAs), Aging and Disability Resource Centers (ADRCs) or Medicaid offices. They have a good understanding of Medicaid eligibility, as well as the alternatives to Medicaid. Also, on the positive side, they do not charge for their services. However, like many public employees, they are often quite busy and cannot provide the same level of service as a professional in the private sector who is being paid directly. Most importantly, private sector advisors can advise individuals on what to do in order to qualify for Medicaid when they are over the income or asset limits. On the other hand, public sector individuals simply provide assistance with the application process. They do not help persons who exceed the Medicaid financial limits to restructure their income and assets appropriately to qualify. Therefore, these individuals should only be used when candidates are certain they meet their state’s Medicaid eligibility requirements.
State Health Insurance Programs Counselors, often called SHIPs Counselors, are individuals who are usually volunteers, trained by the state to be knowledgeable about the existence of public benefits, such as Medicare and Medicaid. Typically, they do not have a deep understanding of Medicaid eligibility nuances and cannot offer assistance about how to qualify. Rather they can explain the eligibility criteria and the application process. They are perhaps best suited for individuals whose income and assets are well below the eligibility thresholds for their states. SHIPs Counselors do not charge for their services.
This category of Medicaid planners, commission-based, is focused on helping individuals whose assets exceed Medicaid eligibility limits. They provide free services to families and individuals and take a commission when they purchase Medicaid compliant annuities to help them meet the Medicaid asset limits. While typically very knowledgeable about Medicaid eligibility, they are less familiar with alternatives to Medicaid, and do not have an incentive to advise clients in those areas. Since they are only compensated through the purchase of annuities, they are unlikely to assist individuals who are not in the position to purchase one. Commission-based Medicaid planners tend to advertise their services under Asset Protection. One should proceed with caution when working with an annuity salesperson / commission-based Medicaid planner.
Insurance agents’ primary goal is to sell insurance products. The purchase of certain insurances can help lower one’s assets so that they meet Medicaid’s asset limit. These are primarily “final expense” insurance policies or burial insurance. In this context, some agents offer free Medicaid planning assistance. However, while useful, it is important to remember that assisting the family is not their primary goal. This is not to say that these individuals cannot provide valuable advice, just that the family should be aware of the potential for a conflict of interests. One might achieve their desired results by working with an insurance agent and a public benefits counselor.
The LTC Ombudsmen program is a federally funded initiative aimed at helping resolve the complaints of individuals that reside in nursing homes, board and care homes, and assisted living residences. While their primary goal is to resolve care issues, they also can provide some counsel on financial matters. They do not charge consumers for their assistance. However, as they are public employees, they will not advise families who exceed Medicaid’s limits on how best to qualify. Instead, they offer factual guidance on the eligibility and application process. They also tend to work mostly with individuals who already reside in nursing homes as opposed to those who are moving into one. Therefore LTC Ombudsmen are most relevant to families who have been private paying for a nursing home and are hoping to transition to a Medicaid-funded payment for nursing home.
It is certainly possible to undertake Medicaid planning oneself without professional guidance. There are many books, websites, and software programs that can help. There are also online legal and financial experts who will answer questions on a one-off basis. While certainly an inexpensive option, one must be organized, patient, analytic, and have a fair amount of time to research the matter. The obvious risk is if one makes an error, they will be denied Medicaid.
Medicaid Planners Comparison Table
As mentioned previously, not every individual providing Medicaid planning advice is appropriate for every family. Everyone’s situation is different and individuals and families should carefully consider what type of Medicaid planning is most appropriate given their circumstances. The table below enables one to compare the strengths and weakness of the various public and private professionals that offer Medicaid planning assistance.
|Elder Law Attorneys||Geriatric Care Managers||Eldercare Financial Planners||Public Case Managers||SHIPs Counselors||Commission-Based Medicaid Planners||Insurance Agents||Long Term Care Ombudsmen||Self-Planners|
|Understand Medicaid law||Yes||Some||Some||Some||Some||Some||Some||Yes||No|
|Familiar with Medicaid alternatives||Some||Yes||Some||Yes||Yes||Some||No||Some||No|
|Understand individual's care needs||Some||Yes||Some||Yes||Some||No||No||Some||Yes|
|Advise clients who exceed Medicaid's financial limits||Yes||Yes||Yes||No||No||Yes||Yes||No||n/a|
|Advise clients who do not exceed Medicaid's financial limits||Yes||Yes||Yes||Yes||Yes||No||No||Yes||n/a|
|Have broad financial planning experience||Some||No||Yes||No||No||Some||No||No||No|
|Have potential conflict of interest||No||No||No||No||No||Yes||Yes||No||No|
|Cost||High||Med||High||No Cost||No Cost||No Cost||No Cost||No Cost||No Cost|