Asset Preservation, Hearings and other Complex Medicaid Challenges
By Karen G. Jackson , Esq.
I. Pre- and Post- Deficit Reduction Act (“DRA”).
- Introduction.
The implementation of the Deficit Reduction Act (“DRA”), 42 U.S.C. 1396p, effective February 8, 2006, which modified the Federal Medicaid Act, has significantly changed the strategies that were used pre-DRA.
This federal law must always be used in conjunction with your particular state’s DRA implementation legislation, if any, for all of your cases. A state is not permitted to change the federal law unless the state applies for, and obtains, a waiver. Practice Note: If no waiver is obtained, and the state law is materially different from the federal law, you have an avenue for appeal, to be addressed in this seminar.
2. Most Significant Changes Between Pre- and Post- DRA.
1. The Look-Back Period, 42 U.S.C. 1396p (c)(1)(B).
Medicaid rules, both pre- and post- DRA, prohibited the transfer of income or resources (“assets”) by individuals requesting long-term care coverage for less than fair market value. The gift is the difference between fair market value and the consideration paid for the asset.
Pre-DRA, the Medicaid applicant only had to report gifts made within the thirty-six (36) month period before the date of application. Post-DRA, the look-back period has been extended to sixty (60) months.
Most states, if not all, have employed a phase-in period, computing the look-back period by counting the number of months backwards from the date of application to February 8, 2006, up to a maximum of sixty (60) months. For example, the look-back period was thirty-six (36) months until March 8, 2009, when the look-back period became thirty-seven (37) months, and so on, until the maximum sixty (60) months’ period will be fully phased in for any Medicaid application filed on or after March 8, 2010.
2. Start Date of Gift Penalty, 42 U.S.C. 1396p (c)(1)(D).
Pre-DRA, the gift penalty period started from the date of transfer. This rule permitted Medicaid planners to employ the so-called “half a loaf” strategy. However, post-DRA, the penalty period does not begin to run until “the date on which the individual is eligible for medical assistance…”, meaning that the penalty period does not begin to run until after the Medicaid application is filed and the individual would have otherwise qualified “but for” the gift.
As Medicaid planners, this provision is one of the biggest challenges we face.
3. Home Equity.
Pre-DRA, the equity in the residence was fully protected regardless of its equity amount. Post-DRA, Medicaid coverage for long-term care services is prohibited when an individual has home equity in excess of $500,000. Each state has the option to increase this amount up to $750,000. 42 U.S.C. 1396p (f).
4. Penalizing Transactions Involving Annuities.
Pre-DRA, Medicaid qualified annuities purchased before February 8, 2006, must meet the following rules:
- The beneficiary must be the applicant or spouse;
- The total present value of the projected payments from the annuity must be at least the value of the transferred assets;
- The first payment from the annuity must be received within sixty (60) days from the date of application; and,
- The terms of the annuity must provide for equal payments.
Post-DRA, a Medicaid qualified annuity purchased on or after February 8, 2006, is subject to penalty unless the state is named as the remainder beneficiary in the first position for at least the total amount of Medicaid payments made’ or, is named as such a beneficiary in the second position after the community spouse and/or minor or disabled child. 42 U.S.C. 1396p (c)(1)(F)(G).
5. Penalizing Transactions Involving Promissory Notes.
Post-DRA, the definition of assets includes promissory notes. The Medicaid applicant’s transfer of assets in exchange for a promissory note is a permitted transfer if the repayment terms are actuarially sound; provide for payments to be made in equal amounts during the term of the loan and with no deferral or balloon payments; and, prohibits the cancellation of the balance upon the death of the lender. 42 U.S.C. 1396p (c)(1)(I).
6. Undue Hardship Waiver.
Post-DRA, Medicaid benefits are provided in cases where the imposition of the asset transfer or home equity provision would result in undue hardship. The law varies considerably from state to state because each state has the option to establish its own undue hardship appeal process. The state’s procedures must provide basic due process rights, which are discussed in this paper. 42 U.S.C. 1396p (c)(2)(D).
7. Long-Term Care Insurance.
Post-DRA, assets can be retained in an amount equal to the amount paid under a state qualified long-term care insurance partnership policy. 42 U.S.C. 1396p (b).
II. Preserving Assets During Medicaid Planning.
A. The Basics.
1. Transfer Remainder Interest of Residence.
Convey the remainder interest of the Medicaid applicant’s residence to the children/beneficiaries, reserving a life estate. However, if the Medicaid application is filed within the look-back period, a cure will have to be made, with the children/beneficiaries having to deed the home back to the Medicaid applicant or to the community spouse, if married.
2. Purchase an Irrevocable Pre-Paid Funeral.
There is no monetary limit, but caution against the “Cadillac” funeral.
3. Set up a Burial Account.
Set up a burial account for $1,500 at the Medicaid applicant’s representative’s chosen bank. I recommend that the Medicaid applicant’s name be listed first, jointly with the trusted child/beneficiary. This passbook savings account can start at $1,500 and receive interest thereon. It is important to set up the account jointly with a trusted child/beneficiary so the account will not be subject to probate administration. Because these funds will automatically pass to the child/beneficiary upon the death of the Medicaid applicant, the child/beneficiary must be trustworthy. If the child/beneficiary predeceases the Medicaid applicant, it is important that a second representative be added to this account in order to avoid probate administration.
4. Purchase of Annuity by Community Spouse.
The community spouse can purchase a Medicaid qualified annuity, converting the excess assets into an income stream for the community spouse’s benefit. When the spouse/Medicaid applicant qualifies for Medicaid, the community spouse can keep all of the annuity’s income stream.
An Ohio appeals court held that the purchase of a post-DRA annuity by a community spouse is not an improper transfer of assets. Vieth v. Ohio Dept. of Job & Family Services, (Ohio Ct. App., 10th Dist., No. 08AP-635, 7/30/09). The Ohio Court of Appeals reversed the trial court in held that “funds used to purchase an actuarially sound, non-revocable, non-transferable commercial annuity, for the sole benefit of the community spouse, are not countable resources for Medicaid eligibility purposes.” The Court went on to conclude that the DRA amendments to the Federal Medicaid Law did not change the rational behind allowing a spouse to purchase an annuity.
B. Advanced Asset Planning.
State law must always be carefully examined for these issues.
1. Trusts.
a. Testamentary Trust.
This is a trust funded by a will in order to avoid the Medicaid disqualifying transfer of asset rules, as well as the “spousal election” issue (See below). Typically, the pour-over will of the community spouse who predeceased the Medicaid applicant, leaves the community spouse’s assets to the testamentary trust, to be administered by a child/trusted person. The trustee of the testamentary trust is not permitted to use the trust assets for public assistance, but only to supplement the Medicaid applicant’s needs.
b. Irrevocable Income Only Trust.
The grantor of an Irrevocable Income Only Trust (“IIOT”) must irrevocably transfer assets into the trust and is only permitted to receive the income from those transferred assets, not the principal.
The IIIOT works well if it is probable that the Medicaid applicant will not need Medicaid benefits within the five year look-back period. If the Medicaid applicant must file the Medicaid application before the look-back period has passed, technically there is not “cure”; i.e., there is no way to reverse the irrevocable trust. There are “escape hatches” that can be built into the IIOT, but if too many are included in the IIOT, you run the risk of the state Medicaid agency disqualifying it. It is critical that your state law is carefully studied.
The IIOT is an excellent device to hold vacation homes and over-limit assets providing the Medicaid applicant/community spouse with only the income stream. The IIOT is often used to hold even non-countable assets such as the residence.
c. Medicaid Qualifying Trusts.
Because the state is a remainder beneficiary in the following three trusts, the assets transferred into these trusts are not treated as countable in determining Medicaid eligibility. However, please note then See Hobes v, Zanderman (10th Cir., No. 08-2099, 9/1/09), in which the 10th Circuit Court of Appeals held that each state is free to count assets held in (d)(4) and (d)(4)(c) trusts as available resources for Medicaid purposes.
i. Special Needs Trust.
A trust qualifies as a special needs trust under the following conditions:
- The trust contains the assets of an applicant’s/recipient younger than age sixty-five (65) or the assets of other individual;
b. The applicant is disabled;
c. The trust is established for the benefit of the applicant/recipient by a parent, grandparent, legal guardian, or a court; and,
d. The trust requires that upon the death of the Medicaid applicant the state will receive all amounts remaining in the trust, up to an amount equal to the total amount of medical assistance paid on behalf of the applicant/recipient. 42 U.S.C. 1396p (d)(4)(A).
ii. Qualifying (“Miller”) Income Trust.
A trust qualifies as a qualifying income trust only under the following conditions:
- The trust is composed only of pension, Social Security, and other income to the individual, including accumulated interest in the trust;
- The income must be received by the individual and the right to receive income cannot be assigned or transferred to the trust; and,
- The trust requires, that upon the death of individual, the state will receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of the individual. 42 U.S.C. 1396p (d)(4)(B).
iii. Pooled Trust.
A trust qualifies as a pooled trust only under the following conditions:
- The trust contains the assets of an individual of any age who is disabled;
- The trust is established and managed by a non-profit association;
- A separate account is maintained for each beneficiary of the trust but, for purposes of investment and management of funds, the trust pools the funds in these accounts;Accounts in the trust are established solely for the benefit of individuals who are disabled by the individual, by the parent, grandparent, or legal guardian of the individual, or by the a court; and,
- To the extent any amounts remaining in the beneficiary’s account upon the death of beneficiary are not retained by the trust, the trust pays to the state the amount remaining in the account up to an amount equal to the total amount of medical assistance paid on behalf of the individual.
2. Property Essential for Self-Support.
Business or non-business property essential for self-support can be treated as non-countable. For example, this is a useful technique to maintain non-residential real property generating income needed by the community spouse.
3. Inaccessible Assets.
Any assets not accessible to the Medicaid applicant are non-countable; for example, property subject to probate; divorce; held up by a life insurance company. Any inability to sell or receive the benefits of an asset after a due diligent attempt has been made to collect such asset is non-countable. This issue usually requires an appeal.
4. Spousal Refusal.
If the community spouse refuses to cooperate, the marital assets controlled by the community spouse are non-countable.
5. Gift and Promissory Note.
42 U.S.C. §1396p (c)(1) requires that promissory note payments must be paid in equal amounts during the term of the loan; with no deferral and no balloon payments made; and, prohibits the cancellation of the balance upon the death of the lender.
One example: the Medicaid applicant’s excess assets are exchanged for a promissory note from the children. The note must meet the requirements set forth in the DRA and state law. The children’s payments can be made to the Medicaid applicant/community spouse, who is the lender, or used to pay the provider directly.
This accomplishes the immediate conversion of excess assets to an income stream; and, the Medicaid applicant will qualify for Medicaid almost immediately.
This technique works much better for a married couple; however, for an individual, benefits can also be derived from this approach.
6. Annuities.
This involves the same concept as with promissory notes, but through the use of annuities instead. To work, the annuity must be irrevocable and non-assignable, purchased for the benefit of the community spouse.
A typical example: the Medicaid applicant/spouse purchases an annuity, providing a stream of income. An actuary expert computes the present value of the annuity income stream, which is usually under twenty-five percent. The children purchase the annuity by paying its present value in a lump sum payment. Upon the purchase of the annuity, the children begin to receive its stream of income. The lump sum payment made by the children to the Medicaid applicant/spouse is considered a countable resource, which must be spent down until the Medicaid applicant qualifies for Medicaid benefits. The children continue to receive the annuity’s income stream, even though they only paid under twenty-five percent (25%) of the value of the parent’s asset.
For example, the Medicaid applicant purchases a post-DRA qualified annuity for $400,000, then the Medicaid applicant enters a nursing home. Using a twenty-five (25%) percent value estimate, the children pay the Medicaid applicant $100,000 for ownership of the annuity contract of $400,000. After the Medicaid applicant has spent down the $100,000 received from the children, the Medicaid applicant will immediately qualify for Medicaid. The children, not the nursing home, receive the income stream because the children paid for that benefit.
7. Family Care Agreement.
a. Best Chance of Success.
The best chance of success for a family care agreement to work is one that follow these rules:
- The caregiver is paid weekly/monthly based upon actual services rendered, supported by timesheets, before the Medicaid applicant enters a nursing home.
- A physician or other expert documents the need for such services. For example, the physician states in writing that the Medicaid applicant is unable to do one or more activities of daily living.
- The caregiver is responsible to pay income taxes for all money received.
b. Issues to Avoid.
- No professional documentation to support the need for caregiver.
- Lump sum transfers for future services.
- Services rendered while the Medicaid applicant is in the nursing home.
A New York appeals court held in Matter of Barbato v. New York State, (N.Y. Supp. Ct., App. Div., 4th Dept., No. 711 TP 08-02216, Aug. 21, 2009), with related cases. In this case, the court held that transfers for future personal services were not for fair market value “because there is no basis upon which to conclude that the transfer of a specific amount of assets for services that may or may not be rendered is for fair value.” The court further noted that in the absence of a refund provision in the care giver agreement, the care giver could receive a windfall if the Medicaid applicant did not meet his or her life expectancy.
III. Medicaid Hearing Strategies.
A. Procedural Practice Tips.
1. Claim of Appeal.
Spot any challenging issues as early as possible in the process as you prepare the Medicaid application for your client. When the Medicaid application is filed, include the applicable law, with explanation. If your client’s Medicaid application is denied, immediately file your claim of appeal. It is better to later withdraw your appeal than to miss the deadline, which is usually short.
2. Do Not Be Intimidated.
3. Review Entire File.
Make arrangements to carefully review the entire file before your hearing. Often you will find surprises. You have the right to obtain any and all copies of the documents you request. Preferably, do not review the file on the day of the hearing. You want to have enough time to adequately prepare.
4. Your State’s Administrative Procedure.
Before the hearing, study your state’s administrative procedure rules carefully. Determine whether or not the rules of evidence are strictly observed during the hearing procedure. Before the hearing, go through each proposed exhibit and anticipated testimony to analyze which rule(s) of evidence you will use to get each piece of proposed testimonial and documentary evidence entered.
5. Feel Free to Call the Hearing Office.
Before the hearing, you can call the state agency to speak to an appeal’s clerk to ask your questions. For example, if you desire to appear at the hearing telephonically, ask if that is an acceptable procedure. Practice Tip: whenever possible, have your hearing in person.
6. Research.
Research all case law, appeal decisions, and federal law on your issue(s). Often, the facts are undisputed, but there is a disagreement as to how to apply the law to the facts. If there is a factual dispute, carefully prepare your client and any other witnesses to truthfully testify as to all necessary facts. If you must appeal from the hearing, you want to make certain that all appropriate evidence has been entered.
If a key witness is not able to attend the hearing, you will likely have a couple of options. For example, your witness could testify telephonically; or you can take that witness’ deposition in advance of the hearing.
7. Submit Your Information in Advance.
In advance of the hearing, submit to the hearing officer, with copies to the state agency representative, all of your proposed exhibits and legal arguments. This is an excellent opportunity to present your case before the hearing.
8. Additional Time.
If, at the hearing, you are surprised or need additional time for other reasons, ask to keep the record open so you can submit additional documents and/or testimony. Alternatively, simply ask to continue the hearing.
9. Record.
It is critical that you ensure that a complete record is being made of your hearing. If you must file an appeal with the court, you will want your entire record before the judge.
10. Timely Submit.
Timely submit all additional documents required by the hearing officer.
11. File Your Appeal to the State Court.
If the Appeal Decision is incorrect, file your appeal with the proper court in your state timely. Strictly follow the procedural law of your state. A typical standard for judicial review is that the agency action is “based on an error of law or on unlawful procedure, arbitrary and capricious or unwarranted by facts found by the agency and supported by substantial evidence.” The Plaintiff bears the burden of proof.
B. Issues Frequently Appealed.
1. Community Spouse’s Minimum Monthly Maintenance Needs Allowance (“MMMNA”).
The community spouse is entitled to keep all of his/her income. If the community spouse’s income amount is not adequate, the state agency will determine the community spouse’s Community Spouse’s Minimum Monthly Maintenance Needs Allowance (“MMMNA”). This is the amount of income needed by the community spouse to meet basic needs. If the community spouse’s income does not meet this threshold, the state agency will allow the community spouse to retain as much of the Medicaid applicant’s income needed to meet the MMMNA.
Frequently, an appeal must be filed to seek an increase in the MMMNA set by the Medicaid agency. If you must appeal this issue, carefully prepare your facts to support the community spouse’s claim that more income is needed to meet the community’s spouse’s basic needs.
2. Community Spouse Resource Allowance (“See CSRA”). 42 U.S.C. 1396r-5(f)(2).
The Community Spouse Resource Allowance (CSRA) is the amount of assets set aside for the Medicaid applicant’s spouse. This allowance is not considered “available” to the Medicaid applicant and is not used to determine eligibility for Medicaid. If, after setting aside the CSRA, the Medicaid applicant still has non-except assets in excess of $2,000, the couple must reduce the excess to be eligible for Medicaid benefits, unless excess assets are required to maintain the community spouse’s basic income needs.
If the combined income of both spouses is insufficient to satisfy the MMMNA, the community spouse can request an increase in the CSRA so as to generate enough income to achieve the MMMNA.
In this situation, 42 U.S.C. 1396r-5 (e)(2)(c) requires the state agency to revise the CSRA to an “amount adequate.” The state’s procedures must adhere to these federal standards. This issue must usually be appealed.
Frequently, the state Medicaid office will use an unrealistically high interest rate to make these calculations, which results in a lower level of permitted asset amount. This issue can be successfully appealed.
A compelling case can be made by proving that the community spouse’s income is inadequate and that the interest rate applied should be based on an actual interest income available to elderly couples. The preparation of the community spouse’s testimony with supporting documentation can achieve this goal.
If the hearing officer “rubber stamps” the procedures used by the state agency, I recommend that you appeal the decision by use of the standard stated above.
3. Appeal the State Agency Decisions as Inconsistant with Federal Law.
a. Promissory Notes.
In G.L. v. Division of Medical Assistance, (New Jersey, 07/17/08), the Court granted Plaintiff’s motion for summary decision. In this case, the Medicaid applicant made an $86,000 loan to her son in exchange for a promissory note. The note was non-negotiable, non-assignable, non-transferable, and had to be paid during the Medicaid applicant’s life expectancy, making it actuarially sound. There was no deferral of payment nor balloon payment. There was proof it could not be sold on the open market. The Medicaid applicant filed her appeal from the state agency’s imposition of a transfer penalty. The Court found in favor of the Medicaid applicant holding that the promissory note was excluded by definition pursuant to the DRA because the subject note met all of the DRA criteria set forth at 42 U.S.C. 1396p (c)(1)(l). The state agency argued that a transfer of assets for less than fair market value is prohibited. The note had no value because it could not be sold on the open market.
The Court rejected the state agency’s argument by holding that a qualified promissory note is not a transfer of assets, and therefore is not subject to a definition of fair market value.
Essentially put, this case opens the door to a powerful planning strategy. Moreover, it provides a good example of the use of the federal Medicaid law and DRA to “trump” state law through the appellate process. See Weatherby v. Richman, for a post-DRA analysis.
b. Annuities.
See A. B. v. Division of Medical Assistance and Health Services, e.t. all, Superior Court of New Jersey, Appellate Division (Decided 1/21/05), for another example of a successful challenge of state law not in conformity with the Federal Medicaid Act, amended by the DRA. In this case, the court concluded that the Federal Medicaid Act prohibits the state from treating an actuarially sound commercial annuity as an available resource of the community spouse; and, that the state may not require that it be named as the remainder beneficiary of such an annuity.
c. Penalty Divisor Calculation.
There are widely divergent state calculations of the monthly penalty divisor required under the Federal Medicaid Law. The number is supposed to be the average private pay rate of a semi-private/private room in a facility.
If you state uses an incorrect number, this rate can be challenged on appeal, if helpful to your client.
d. Undue Hardship Waiver.
To obtain the undue hardship waiver an appeal/request for fair hearing is usually required. Because this is a very fact specific appeal, carefully prepare the testimony of your witnesses and documents.
If the hearing officer is not persuaded and you must file your matter in state court, a challenge can be made to the state law as defective because the hearing process provided insufficient due process rights. 42 U.S.C. 1396p (c)(2)(D).
e. Violation of Due Process Rights.
i. Basis.
A solid basis for appeal is the claim that the Medicaid applicant’s due process rights were violated. In O’Bannon v. Town Court Nursing Center, 447 U.S. 773, 787 (1984), the United States Supreme Court held that Medicaid recipients were entitled to procedural due process rights before direct benefits could be terminated. In Garret v. Puett, 717 F. 2d 930, 931 (6th Cir. 1983) the Sixth Circuit held that adequate notice for the reduction or termination of Medicaid benefits required four elements:
- A detailed statement of the intended action,
- The reason for the change in status,
- Citation to the specific statutory section requiring reduction or termination,
- An specific notice of the recipient’s right to appeal. See Moffitt v. Austin, 600 F. Supp. 295, 297 (1984).
ii. Hearing officer.
The Code of Federal Regulations requires that all hearing be conducted by “one or more impartial officials or other individuals who have not been directly involved in the initial determination of the action in question.” 42 C.F.R. §431.240 (2006) In Goldberg v. Kelly, 397 U.S. 254 (1970), the Court held that the hearing officer’s decision be based “solely on the legal rules and evidence adduced at the hearing.” p. 271 The hearing officer is required to cite to the specific regulations that dictate the ruling.
iii. Burden.
This is a complex issue that has minimal case law. In Collins v. Eichler, 1991 Del. Supr. LEXIS 105, the Superior Court of Delaware found the burden of proof to be on the state when termination or reducing Medicaid benefits. In Weaver v. Colorado Department of Social Services, the Colorado Court of Appeals articulated the states burden to show a change in a recipient’s circumstances before benefits can be reduced or terminated.
iv. Right to Face Accuser and Subpoena Witnesses.
The court in Goldberg held that a welfare recipient has a right to face adverse witnesses. “In almost every setting in which important decisions turn on questions of face, due process requires an opportunity to confront an cross-examine adverse witnesses.” Goldberg, 397 U.S. 254 at 269.
v. Right to Record.
42 C.F.R. §431.233 (a)(2006) entitles the applicant to record the hearing and receive a transcript of the proceedings. This is critical if the Medicaid applicant will file an appeal from the agency’s decision. See Bowden v. Delaware, 1993 Del. Super. LEXIS 304 (Del. Super. Ct. 1993)
IV. Additional Complex Issues in Medicaid.
A. Question of Whether the Application Needs to be Filed and Denied to begin the Penalty Period.
B. The Phase-In of DRA.
C. Argue that the Resources were Transferred “Exclusively for a Purpose Other than to Qualify for Medicaid.”
For gifts made within the look-back period, an argument can be made that the resources were transferred “exclusively for a purpose other than to qualify for Medicaid.” Search the law in your state for any similar language. It is quite common for a Medicaid applicant to innocently give money to his/her children without any awareness, whatsoever, of the Medicaid law. With excellent documentation such as affidavits prepared by the children and parents stating the real reason the money was gifted, you have a good change of success. I have often had clients who gave their money to their children for reasons other than to qualify for Medicaid; for example, the child was in financial distress. With excellent documentation and upon requests for fair hearing this might give you success if the gifts cannot be returned.
D. Divorce.
Study the proofs required for divorce in your state. If the community spouse can honestly testify that the marriage has irretrievably broken down (or whatever language is used in your state), you can request the divorce court to award spousal support in excess of the MMMNA and award assets in excess of the CRSA.
E. Post Eligibility Transfers by Community Spouse.
Some states are attempting to block post-eligibility transfers by a community spouse. However, there is no basis in the DRA to support this attempt.
“Under the transfer of assets provisions in §1917(c) of the Social Security Act (the Act), transfers between spouses are except from any transfer penalty. Under the spousal impoverishment provisions of §1924 of the Act, one eligibility is determined, the resources of the community spouse are no longer considered available to the institutionalized spouse. Thus, after the month in which an institutionalized spouse is determined eligible for Medicaid, and resources belonging o the community spouse are solely the property of that spouse. That is, the community spouse can do whatever he or she wants to do with them.” (emphasis supplied).
Health Care Financing Administration (HCFA), Ronald Preston, Associate Regional Administration, Region 1, Boston, Massachusetts to Brian E. Barreira (“the Barreira letter”) April 5, 2002.
F. Estate Recovery.
The best approach to minimize the impact of estate recovery are the following two techniques.
1. Remainder Deed.
Before or at the time of the Medicaid application, the parents execute a deed conveying the remainder interest in their home to their children/beneficiaries, retaining a life estate. If state law permits, this allows the home to bypass probate administration and the estate recovery process, the home vesting immediately with the children/beneficiaries upon the second death of both parents.
2. Pour-Over Will and Testamentary Trust.
The pour-over will and testamentary trust have been previously addressed in this paper.
The information provided in this Article is meant as general information regarding Medicaid. This information is not intended as legal advice for any one situation. The information provided is meant to be educational for an individual or attorney and provides a variety of possible Medicaid planning solutions. If you have questions regarding your specific circumstances please feel free to contact Attorney Karen G. Jackson to discuss your matter.