What Every Estate Planning Attorney Needs to Know About Medicaid Planning
Session 1: Introduction & Overview – Medicaid Planning and Spend-Down
By: Lindsay V.R. Moss, Esq.
Managing Principal, Moss Law, LLC
October 10, 2025
Lindsay Moss opened the series with a practical introduction to Medicaid planning for estate planning attorneys.
She reviewed how Medicaid long-term care works and outlined the essential differences between Maryland and D.C. rules.
- Crisis versus Pre-Crisis Planning: clarified when planning occurs during a medical crisis versus early in the diagnosis stage and how strategies differ.
- Eligibility Requirements: explained both medical and financial criteria for Medicaid long-term care, including activities of daily living and asset limits.
- Maryland and D.C. Differences: compared resource thresholds, treatment of retirement accounts, home equity rules, and how each jurisdiction handles waivers and recovery.
- Spend-Down Strategies: described how to convert countable assets into exempt ones through steps such as paying debts, home improvements, vehicle purchases, and prepaid funeral arrangements.
- Single Applicant Planning: reviewed the use of promissory notes and gift-and-loan combinations to preserve a portion of assets during a crisis spend-down.
- Married Couple Planning: discussed how Medicaid-compliant annuities can shift excess resources to income for the community spouse and protect savings.
- Transfer Rules: outlined the five-year look-back period, penalty calculations, and permissible transfers to spouses, disabled children, and certain trusts.
- Asset Protection Tools: introduced techniques such as life estate deeds without powers, caregiver child exceptions, and Maryland ABLE accounts.
- Eligibility and Estate Recovery: emphasized analyzing both the front-end qualification for benefits and the back-end exposure to estate recovery after death.
Her presentation set a collaborative tone for the series, encouraging open discussion and questions as attorneys begin integrating Medicaid strategies into their estate planning work.
