Course Outline

Medicaid Planning from A-Z
Based on Content from The Medicaid Planning Guidebook

Course Syllabus

Session 1: What is Medicaid Long-term Care?

  1. History of Long Term Care Medicaid/Medi-Cal.

    • Legislation

    • Terminology

  2. Institutional Care v HCBS and Waiver Services

  3. Medicare v Medicaid

  4. Critical Stages of Medicaid Planning

  5. Medicaid Qualification

    • Who is eligible to apply

  6. When to file an application

  7. Medicaid Long Term Care Source of Law

    • Federal Program Run by the States

    • Federal Authorizing Statute

    • State Authorizing Statute and State Plan

    • State Regulations and State Eligibility Handbook/Manual

  8. Basic Asset Eligibility Philosophy

Session 2: Understanding Medicaid Eligibility Rules and Procedures

  1. Planning Stages and Methodology

    • Establishing an intake system and organizational base

    • Critical dates in a Medi-Cal Planning case

  2. Categorizing Assets

    • Protected/Exempt

    • Unprotected/Available

  3. Resource Allowances

    • Individual

    • Two Married Couples in Facility

    • Community Spouse

  4. Calculating the Spenddown

    • Single Spenddown

    • Marital Spenddown with No Community Spouse

    • Community Spouse Spenddown

    • Common Mistakes and Helpful Error Margins

  5. Home Equity Limit

Session 3: Divestment Penalties and Divestment Planning

  1. What is a divestment?

    • Gifts and transfers

    • Less-than-fair-market-value test

    • Disclaimers

  2. What is the lookback?

    • Lookback planning from 1988 to present

    • Determining the lookback period

    • Global lookback issues

  3. How to calculate a divestment penalty?

    • Identifying the divisor

    • Identifying the penalty start date

    • Calculating the penalty period

  4. Divestments that Do Not Cause Penalties

    • Exempt Transfers

    • Transfers of Exempt Assets

    • Post-eligibility transfer issues

  5. Creating intention divestment penalties?

    • Half-a-loaf gifting

    • Divestment as a planning too

Session 4: Additional Asset Protection Medi-Cal Eligibility Strategies

  1. Basic Strategies

    • Shift Assets from Countable to Non-Countable

      • Home Equity

      • Primary Vehicle

      • Personal Property

      • Pre-Paid Funeral or Burial

    • Caregiver Agreements

  2. Convert Assets to Income

    • Medi-Cal Compliant Annuity

      • Requirements

      • Use of balloon annuities

    • Promissory Note

  3. Gift and Wait

  4. Gift and Apply

  5. Long-Term Care Partnership Program Policies

Session 5:  Income Eligibility

  1. Income Cap state v. Non-Income Cap state

  2. Medically needy pathway

  3. Community Spouse Income Allowances

    • How the MMMNA works

    • Calculating the MMMNA

  4. Planning strategies to increase spousal income allowance

 Session 6: Applying For Medicaid

  1. Preparing and filing the application

    • When to file

    • Where to file

    • How to file

  2. Verifications

    • Residency and citizenship

    • Assets

    • Income

    • Transfers

  3. Office Actions

    • Approvals

    • Denials

    • Request for Information

    • Annual review

    • Income adjustments

  4. Post-eligibility issues

    • Duty to report

    • Post-eligibility assets

    • Change of Circumstances

    • Death of a community spouse

    • Undue hardship waivers for punitive divestments

Session 7: Advanced Advocacy

  1.  Fair Hearings

    • Office inaction

    • Correcting an approval error

    • Improper Denial

    • Filing the request

    • Representation at the hearing

  2. State/Federal Court and Appellate Advocacy

    • Exhaustion of administrative remedies

    • Appeals available through state court

    • Concurrent jurisdiction of federal court

Session 8: Estate Recovery

  1. Medicaid estate recovery rules

    • Scope of assets to be recovered from

    • Assets exempt from recovery

    • Use of undue hardship waivers

  2. Methods to Reduce Recovery

Session 9: VA Aid and Attendance

  1. Overview of Aid & Attendance

    • What is the Improved Pension

    • How much can a person receive

    • Who is eligible to apply

    • VA A&A terminology

  2. Four Pillars of A&A Eligibility

    • Wartime Service

    • Medical Necessity

    • Net Worth Limits

    • Income For VA Purpose Calculation

  3. Planning Strategies for VA A&A

    1. Divestment

      • No divestment penalties

      • Effect of divestment on future Medicaid eligibility

      • Non-divestable asset

    2. VA-Compliant Annuities

    3. Homestead exemption and sale issues

  4. Application for VA Aid & Attendance

    1. Intent to File and establishing a claim date

    2. Application and application processing

    3. Fee prohibition on charging

  5. Medicaid and VA Aid & Attendance Harmonization

    1. Uses of A&A to supplement Medicaidl Planning

    2. Effect of Medicaid eligibility on VA benefit

 Session 10: Practical Issues and Ethical Concerns

  1. Multi-discipline approach to planning

  2. Lawyers working with non-lawyers

  3. Common fee structures

  4. Marketing Medi-Cal Planning Services

  5. Sales and uses of annuities

  6. Certified Medicaid Planner designation

Top