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Senior Planning Medicaid Guide

When a loved one’s condition necessitates long-term care it is only natural for myriad questions to surface. The plethora of options and venues can be dizzying, but often the biggest concern is funds.



One of the major obstacles to pursuing excellent long-term care is the prohibitive cost associated with nursing homes, assisted living and in-home care. Most average Americans, even those with sizeable retirement funds, find themselves unprepared for the staggering  and often ongoing cost.  Fortunately, there is help to be had, and in many scenarios Medicaid can step in and pick up the tab.


Medicaid Overview: Medicaid was established in 1965 as a joint federal and state program as a safety net to help seniors fund their long term care.  Long Term Care can refer to multiple programs two of  which will be covered here; Institutionalized Medicaid, otherwise known as nursing home Medicaid, and Global Options Medicaid which covers assisted living and in-home care.

Senior Planning


Medicaid application process: The Medicaid application process tends to be quite complicated and we will break in down in this guide. In general, Medicaid will only cover for those eligible under the program guidelines. They will require extensive amounts of paperwork to prove eligibility and may reject an applicant on the grounds of minor details which have been overlooked.


Medicaid Eligibility: Medicaid requires three areas of eligibility:


  • Citizenship status. In order for any applicant to be approved, they must first prove their citizenship status. Only US citizens or legal aliens are covered by Medicaid.


  • Medical status. Medicaid will need to verify the medical need of the applicant by having forms signed by the physician and a family member submitted to Medicaid for approval.


  • Financial status. Finally, an individual’s net worth need to be established, and herein lays the key to either a successful application or a failed one.


Some Rules and regulations:  Medicaid guidelines vary by state, and there are many rules, regulations, and exceptions that govern eligibility. Covering it all is beyond the scope of this guide, but below is a brief outline of some of the key terms you will encounter during the application process.


  • ‘Spend down’. This is the term used for spending down ones assets to meet Medicaid guidelines and aid in one’s eligibility. As mentioned above, Medicaid is co-sponsored by the federal and state governments and hence varies greatly from state to state on income and asset limits, as well as other eligibility guidelines. The ‘spend down’ process can be tricky, and often the help of a qualified Medicaid consultant is advisable.


  • ‘Look back’. Medicaid reserves the right to request up to 5 years of bank statement before determining an individual’s financial status. If they uncover large monetary gifts they may penalize the applicant with a period of ineligibility corresponding to the amount of money that was gifted before stepping in to cover long-term care.   


  • Some the assets that Medicaid will count towards the bracket include checking and savings accounts, CDs, stocks, bonds, life insurance policies with cash value, among others.


  • ‘Excludable assets’. Assets that are not generally counted against eligibility include personal possessions, irrevocable trust funds for funeral,  a burial plot, a special needs trusts, life insurance policy with no cash value or a face value of less than $1500, as well as some other exceptions for the community spouse.


  • ‘Community spouse’. The spouse of the nursing home resident may keep some of the assets, including the primary residence and one vehicle. The child of the nursing home resident may also keep the primary residence if they are less than 18 years old,legally disabled and, in some cases, if they have provided fulltime in-home care for the applicant.

Documentation: Medicaid is notorious for the piles of paperwork they request. Every applicant is required to provide extensive documentation to verify their


  1. 1.Identity
  2. 2.Age
  3. 3.Marital Status
  4. 4.Financial Status


Failure to provide the correct documentation by specified deadlines can be grounds for denial.  It is imperative that you gather all the paperwork, and submit the application correctly the first time around. A complete documentation checklist along with the definitions of the required documents can be found here.


How we can Help: We at Senior Planning Services are intimately familiar with all the ins and outs of the Medicaid application process, and helped thousands of applicants  achieve  maximized eligibility and benefits.



Our Services include:


  • A  free consultation
  • Constant contact with your board of social services caseworker
  • Collection of documents from vital statistic, if necessary
  • Assistance in the complex ‘spend down’ process and liquidation of life insurance policies and the like.
  • Updates for our clients on a regular basis throughout the entire process


Our comprehensive service includes every aspect of the Medicaid application process through the final approval. Reach out for a free consultation today.


Visit us at: call toll free at 855-S-PLANNING (855-775-2664)

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