Understanding Free Medicaid Application / Planning Assistance Options

Summary
Families looking for free assistance with the Medicaid long term care application and planning process can be referred to resources like Area Agencies on Aging (AAA), legal aid organizations, pro bono legal services and State Health Insurance Plans (SHIPs, which are known by various names in different states). While those resources can provide help, many are too overwhelmed to be reliable or thorough, and some only offer basic information. Plus, if your client is over their state’s Medicaid financial limits, free assistance is probably not an option. Seniors who don’t know if they meet Medicaid’s financial limits can use this national, Medicaid long term care eligibility criteria search tool to find out. Certified Medicaid Planners and Elder Law Attorneys may also offer free help in their initial consultations, and your clients may find it’s worth paying for their full services in the end.

Medicaid Application Support vs. Medicaid Planning

Medicaid application support refers to assistance with completing the application paperwork. This sometime includes assistance gathering all the financial documents required for the application but usually this task falls on other family members. Medicaid planning, on the other hand, refers to assistance with strategies that can help seniors meet Medicaid’s financial limits by reorganizing and reducing their financial resources without violating the Look-Back Period. Thereby helping spouses continue to live independently, preserving resources for other family members and ensuring the individual in need of care qualifies for Medicaid.

Whether they need assistance with planning or with the application, clients with complicated financial situations will likely not get the full range of help they need for free. For seniors with uncomplicated finances, a point in the right direction or a few words of advice from a free resource may be all the help they need to plan or apply for Medicaid Long Term. Still, either process can become overly complex in a hurry.

Free Assistance Options

The following are the most widely-used free Medicaid assistance options:

Area Agencies on Aging

There are more than 600 organizations nationwide that form the Area Agencies on Aging (AAA) network. Many of them have Area Agency on Aging in their name, like the Western Reserve Area Agency on Aging in Cleveland, Ohio. But many of the organizations in the AAA network are named like a county office, such as the Los Angeles County Aging and Disability Department in California, or the Suffolk County Office for the Aging in New York.

Each AAA organization serves a specific geographic location. Most often it’s a county or counties, but it can vary by agency, even within a state. This speaks to the main challenge with AAAs – each one offers different services, even within the same state, and there is no online search tool to find which offices provide which services. This means one has to contact the AAA just to find out if they offer any assistance with Medicaid applications. If your client needs help with Medicaid planning, there is no need to contact an AAA office because they do not provide assistance with planning but they may with Medicaid application support.

AAA offices that do provide help with Medicaid applications will do so through a Benefits Counselor, also called a Benefits Case Manager. While these people may provide seniors with hands-on help completing the application paperwork, they will not offer hands-on help when it comes to gathering the required financial documents. At best, they will inform seniors which documents they need and where to find them.

Even if an Area Agency on Aging has a Benefits Counselor that offers Medicaid application support, seniors should be aware that it can be difficult connecting with anyone at the AAA and actually getting that support. In our experience working with AAAs, they are full of hard working, dedicated and helpful individuals who are often overwhelmed and understaffed. This is especially true now with the post-Covid, Medicaid unwinding (redetermination process). Seniors should also be warned that some AAA locations may only provide information about how to apply for Medicaid, and not actual hands-on help.

AAA Pros
• Can provide free information and guidance
• Benefits Counselors may provide Medicaid application support

AAA Cons
• Will not provide Medicaid planning assistance
• Services offered vary by office
• Some offices may only offer information on Medicaid
• Often understaffed and overwhelmed

This search tool can locate AAA offices by zip code or city.

Legal Aid Organizations

There are roughly 130 legal services centers across the country that offer legal assistance to low-income Americans. They don’t help with all legal matters, but these nonprofit legal aid centers do provide help with public benefits, including Medicaid.

Most of these centers have strict, and low, financial limits. So, if a senior needs help with Medicaid planning because they are over Medicaid’s financial limit, chances are they won’t meet the financial limit for the legal services center. However, some legal services centers have more moderate limits, and some Medicaid planning cases may meet the less strict restrictions.

Low-income seniors who have very limited resources and only need help with the application process are more likely to meet the financial limits and find some of the help they need at legal services centers. While these organizations will assist with completing the application paperwork and inform the senior which financial documents they need for the application, they will not provide hands-on help actually gathering those documents.

Like Area Agencies on Aging, many of these centers are overwhelmed with requests for assistance and they simply don’t have staff to provide that help. In our experience, a local Area Agency on Aging may refer a senior to the nearest legal services center, which may try to refer the senior back to the Area Agency on Aging.

This search tool from the Legal Services Corporation (LSC) can locate legal aid organizations across the country. LSC is a nonprofit entity established by Congress in 1974 to provide financial support for civil legal aid. It currently funds legal aid organizations in every state and the District of Columbia.

Pro Bono Legal Services

Pro bono legal programs connect volunteering lawyers with low-income people who are in need of legal help. In our experience, pro bono lawyers offer free guidance to seniors, including advice on which paperwork they need to complete and what documents they might need to gather. However, pro bono lawyers don’t actually create plans, organize documents or complete applications. And they are not necessarily familiar with Medicaid.

The American Bar Association keeps track of all pro bono programs across the country and lists them in this directory.

State Health Insurance Assistance Program

The State Health Insurance Assistance Program (SHIP) provides low-income seniors with free assistance, counseling and education concerning Medicare. Some SHIP counselors may know about Medicaid, but these counselors are usually volunteers who have been trained by the local SHIP office. In general, they will refer seniors with questions about Medicaid to the state Medicaid offices.

The Administration for Community Living’s Office of Healthcare Information and Counseling manages SHIP, working with offices in all 50 states, the District of Columbia and Puerto Rico. Some states use different names for the program, such as the Senior Health Insurance Information Program (SHIIP) in Arkansas, the Health Insurance Counseling and Advocacy Program (HICAP) in California and Serving Health Insurance Needs of Elders (SHINE) in Florida.

Insurance Agents / Annuity Salespeople

Insurance agents selling annuities may claim to offer free assistance with Medicaid planning, but seniors should be very wary in these situations.

A Medicaid Compliant Annuity might be a sound Medicaid planning strategy for some seniors, but in order for it work the annuity has to meet Medicaid standards. If it doesn’t, a purchasing senior could be penalized with a period of Medicaid ineligibility. That may matter to some annuities salespeople, but the best interest of the senior/customer is usually not their priority. Purchasing a Medicaid Compliant Annuity is a complicated process which needs to consider the amount of resources, marital status, and many state-specific laws.

Not all states treat annuities the same in terms of Medicaid, but, in general, annuities must meet the following conditions to be considered Medicaid compliant:
• They must be irrevocable, non-transferable and actuarially sound.
• The payments must be immediate and fixed (as opposed to deferred or variable).
• The beneficiary must be the state.
• The owner of the annuity must get back all of what was paid during their life expectancy.

While Medicaid Compliant Annuities can help a senior get under the Medicaid asset limit, it’s important to remember the income from the annuity payments, which must begin immediately, will count toward the senior’s Medicaid income limit.

What Attorneys and Certified Medicaid Planners Offer in Their Initial Consultations

If seniors aren’t finding enough information or assistance from the free resources in their area, they should contact a Certified Medicaid Planner (CMPs) and/or an Elder Law Attorney for an initial consultation. Our CMPs do not charge for their initial consultation, and many other CMPs also provide a free consultation to start. Some Elder Law Attorneys may also offer consultations free of charge, but many of them do have an initial consultation fee, or they simply start charging by the hour as soon as they start giving you advice.

During an initial call (or discovery call, as we refer to it), our CMPs will find out the applicant’s age, marital status, state of residence, if they need help with the Activities of Daily Living, what type of Medicaid Long Term Care they are applying for and their current healthcare situation. Our CMPs will also ask about the applicant’s financial situation including their income, assets, IRAs, life insurance policies, veteran and home ownership status. They’ll also determine if the applicant needs a Power of Attorney, a lawyer, a decision maker and how urgent their situation is.

If our CMPs believe we can assist the caller after that discovery call, they will set up a second call with one of our Benefits Advisors. The Advisor will go over the caller’s financial situation and a general plan to gain Medicaid eligibility (if necessary), and then then provide a quote for our services.

Elder Law Attorneys who offer free initial consultations may go through similar processes during their first contact with potential clients. However, it’s important to remember that Elder Law Attorneys tend to be more focused on long term estate planning. So, for clients with complex financial situations planning well in advance of medical need, Elder Law Attorneys can often be the best choice. The same is true for seniors who are involved in complex legal situations, like needing a divorce to become Medicaid eligible or establishing multiple trusts. Elder Law Attorneys are very knowledge when it comes to the Medicaid laws in their state and they are, naturally, well suited when it comes to the paperwork and details of creating legal entities (like trusts) that can be used to help a senior become Medicaid eligible.

This kind of complex legal and financial help will typically be expensive coming from an Elder Law Attorney, who may charge anywhere from $200 to $600 per hour. And most Elder Law Attorneys can not compete with CMPs when it comes to timing and seniors in crisis mode. Since CMPs are so specialized, they can fast track seniors who need urgent help. Elder Law Attorneys typically do not have that kind of quick turnaround capability.

Compare Medicaid Planning Assistance Options

Comparing Medicaid Planning Assistance Options
	Provides Information on Medicaid applications and planning	Offers hands-on support for Medicaid applications	Offers hands-on support for Medicaid planning	Prioritizes client’s care needs	Understaffed	Cost
Area Agency on Aging	Yes	Maybe	No	Yes	Yes	Free
Legal Aid Organization	Yes	Yes	Maybe	Yes	Yes	Free
Pro bono lawyer	Yes	No	No	Yes	Some	Free
State Health Insurance Assistance Program (SHIP)	Maybe	No	No	Yes	Yes	Free
Insurance Agent	Maybe	No	No	No	No	Product dependent
Certified Medicaid Planner (CMP)	Yes	Yes	Yes	Yes	No	Case dependent, but typically $4,000-$8,000
Elder Law Attorney	Yes	Yes	Yes	Maybe	No	Case & state dependent, but typically $10,000 – $15,000