Nuts & Bolts of Adding Medicaid Planning to Your Practice (9 CLE HRS)
Course Syllabus
S ession 1: What is Medicaid Long-term Care?
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History of Long Term Care Medicaid/Medi-Cal.
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Legislation
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Terminology
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Institutional Care v HCBS and Waiver Services
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Medicare v Medicaid
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Critical Stages of Medicaid Planning
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Medicaid Qualification
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Who is eligible to apply
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When to file an application
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Medicaid Long Term Care Source of Law
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Federal Program Run by the States
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Federal Authorizing Statute
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State Authorizing Statute and State Plan
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State Regulations and State Eligibility Handbook/Manual
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Basic Asset Eligibility Philosophy
Session 2: Understanding Medicaid Eligibility Rules and Procedures
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Planning Stages and Methodology
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Establishing an intake system and organizational base
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Critical dates in a Medi-Cal Planning case
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Categorizing Assets
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Protected/Exempt
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Unprotected/Available
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Resource Allowances
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Individual
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Two Married Couples in Facility
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Community Spouse
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Calculating the Spenddown
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Single Spenddown
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Marital Spenddown with No Community Spouse
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Community Spouse Spenddown
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Common Mistakes and Helpful Error Margins
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Home Equity Limit
Session 3: Divestment Penalties and Divestment Planning
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What is a divestment?
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Gifts and transfers
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Less-than-fair-market-value test
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Disclaimers
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What is the lookback?
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Lookback planning from 1988 to present
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Determining the lookback period
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Global lookback issues
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How to calculate a divestment penalty?
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Identifying the divisor
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Identifying the penalty start date
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Calculating the penalty period
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Divestments that Do Not Cause Penalties
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Exempt Transfers
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Transfers of Exempt Assets
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Post-eligibility transfer issues
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Creating intention divestment penalties?
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Half-a-loaf gifting
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Divestment as a planning too
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Session 4: Additional Asset Protection Medi-Cal Eligibility Strategies
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Basic Strategies
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Shift Assets from Countable to Non-Countable
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Home Equity
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Primary Vehicle
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Personal Property
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Pre-Paid Funeral or Burial
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Caregiver Agreements
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Convert Assets to Income
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Medi-Cal Compliant Annuity
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Requirements
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Use of balloon annuities
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Promissory Note
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Gift and Wait
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Gift and Apply
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Long-Term Care Partnership Program Policies
Session 5: Income Eligibility
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Income Cap state v. Non-Income Cap state
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Medically needy pathway
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Community Spouse Income Allowances
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How the MMMNA works
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Calculating the MMMNA
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Planning strategies to increase spousal income allowance
Session 6: Applying For Medicaid
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Preparing and filing the application
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When to file
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Where to file
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How to file
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Verifications
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Residency and citizenship
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Assets
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Income
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Transfers
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Office Actions
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Approvals
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Denials
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Request for Information
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Annual review
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Income adjustments
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Post-eligibility issues
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Duty to report
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Post-eligibility assets
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Change of Circumstances
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Death of a community spouse
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Undue hardship waivers for punitive divestments
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Session 7: Advanced Advocacy
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Fair Hearings
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Office inaction
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Correcting an approval error
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Improper Denial
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Filing the request
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Representation at the hearing
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State/Federal Court and Appellate Advocacy
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Exhaustion of administrative remedies
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Appeals available through state court
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Concurrent jurisdiction of federal court
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Session 8: Estate Recovery
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Medicaid estate recovery rules
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Scope of assets to be recovered from
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Assets exempt from recovery
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Use of undue hardship waivers
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Methods to Reduce Recovery
Session 9: VA Aid and Attendance
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Overview of Aid & Attendance
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What is the Improved Pension
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How much can a person receive
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Who is eligible to apply
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VA A&A terminology
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Four Pillars of A&A Eligibility
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Wartime Service
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Medical Necessity
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Net Worth Limits
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Income For VA Purpose Calculation
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Planning Strategies for VA A&A
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Divestment
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No divestment penalties
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Effect of divestment on future Medicaid eligibility
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Non-divestable asset
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VA-Compliant Annuities
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Homestead exemption and sale issues
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Application for VA Aid & Attendance
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Intent to File and establishing a claim date
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Application and application processing
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Fee prohibition on charging
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Medicaid and VA Aid & Attendance Harmonization
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Uses of A&A to supplement Medicaidl Planning
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Effect of Medicaid eligibility on VA benefit
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Session 10: Practical Issues and Ethical Concerns
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Multi-discipline approach to planning
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Lawyers working with non-lawyers
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Common fee structures
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Marketing Medi-Cal Planning Services
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Sales and uses of annuities
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Certified Medicaid Planner designation