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What Is a Medicaid Specialist?

Medicaid helps families from lower income brackets receive medical care.
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  • Written By: Dale Marshall
  • Edited By: C. Wilborn
  • Last Modified Date: 22 August 2014
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A Medicaid specialist, sometimes called a Medicaid consultant, is a person who helps people qualify for Medicaid without exhausting their resources and assets. Medicaid, a program of government insurance funded jointly by the United States federal government and the individual state governments, is designed to pay healthcare costs for the poor, but is also the insurer of last resort for long-term care. It's primarily in this area that Americans may seek the services of a Medicaid specialist, to help them navigate the sometimes complex rules, as well as the limitations on assets and income, imposed on applicants for this government insurance.

In the United States, the cost of medical services for those who cannot afford it, and who have no health insurance, is usually paid by Medicaid. In general, the average American who cannot afford medical services or health insurance has no problem qualifying for Medicaid, and there's no need for a professional consultant to help with the application process. Long-term care, though, is not medical care — only about 5% of the care tendered to such patients is medical in nature, with the remainder being custodial tasks, such as bathing, dressing, and eating. Generally, it's older people who most need long-term care, but since it's not medical care, only a small portion of such expenses is covered by Medicare, the American medical insurance for the elderly.

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The affluent can generally meet long-term care costs either from their own resources or with long-term care insurance. The poor usually already qualify for Medicaid, so if they require long term care, they're already covered. The middle class, however, often cannot comfortably afford long-term care insurance, whose premiums typically are fairly costly, yet their savings and other resources may not pay for an extended period of care, especially if a nursing home is necessary. A Medicaid specialist can help these people qualify for Medicaid without "spending down" all their assets in the process.

When determining assets for the purpose of qualifying for Medicaid, some are considered "countable," and others non-countable, according to rules which very from state to state. In 2010, for example, a person can generally can have assets of no more than about $2,000 US Dollars (USD) and monthly income of $50 USD or so. When considering a couple, however, the spouse not needing the long-term care — the "community spouse" — may keep all of his or her income, and can retain half the couple's assets up to about $110,000 USD, in addition to a house, automobile, and some other personal possessions like clothing and jewelry. Anything above these limits, which are adjusted for inflation annually, must pay for medical or long-term care in a program called a "spend down" process. The Medicaid specialist will analyze the couple's assets and income and formulate a plan to spend the least amount of money necessary in this process, thus preserving as much of the couple's estate as possible.

Many Americans think that as they get older, they'll simply transfer their assets to other family members. The problem with this approach is that Medicaid is legally entitled to a "look back" period of five years, entitling it to reverse any such transactions made in the five-year period prior to the Medicaid application, or to hold the couple financially responsible for the value of any such transactions. A good Medicaid specialist, however, will know how to reclassify assets and even income — legally — to minimize the impact of a spend-down and help preserve the estate.

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