Medicaid Planning Revenue Practice Management

Medicaid Planning as a Growth Engine: How Estate Firms Unlock Predictable Revenue & Client Loyalty

by MedicaidUncategorized

For many estate planning practices, Medicaid planning is seen as a “nice to have” add-on. But the firms that treat it as a core revenue stream are the ones that outperform their peers. By positioning Medicaid planning (and integrated trust strategies like iPug®) as a standard service line, your firm can capture more cases, generate recurring fees, and deepen client retention.

In this post, we’ll dig into hard numbers, operational levers, and a roadmap for turning Medicaid planning into a growth engine for your practice.

The market is enormous — and growing

  • In 2022, the U.S. spent over $415 billion on long-term services and supports (LTSS). Medicaid covered more than 61% of that total. KFF
  • Long-term care costs continue to soar: between 2023 and 2024, the median cost of a private nursing home room rose ~9%, assisted living rose ~10%, and in-home care also increased. Berger Estate & Elder Law P.A.
  • The global elder law / senior-services legal market is projected to double from ~USD 3.6 billion in 2023 to ~USD 7.2 billion by 2033. DataHorizzon Research
  • Many clients mistakenly believe Medicare will cover long-term care. In reality, Medicare’s coverage is limited — placing Medicaid, private pay, and planning at the center of the need. KFF

These numbers indicate a huge demand for Medicaid planning — and a wide gap between that demand and the number of firms offering that service (especially in more sophisticated, compliant ways).

The revenue potential: unit economics and lifetime value

To make the business case clear, let’s break down typical revenue per Medicaid planning client and how recurring fees emerge.

Upfront / project fees

Depending on complexity, Medicaid planning engagements can command fees ranging from $3,000 to $15,000+, especially in cases involving:

  • Married couples with multiple asset classes
  • Trust structuring (iPug®, irrevocable trusts)
  • Medicaid-compliant annuities, promissory notes, QITs (Qualified Income Trusts)
  • Look-back period “repairing” or restructuring older gifts or transfers

(Elder law / Medicaid planning sources often cite those ranges) medicaidplanningassistance.org

So if your firm closes 10 Medicaid planning cases per year at an average of $6,000, that’s $60,000 of new revenue from that service line alone.

Recurring / maintenance revenue

Beyond the project itself, there’s ongoing value:

  • Annual Medicaid recertification and eligibility reviews
  • Trust / asset management and updates over time
  • Updates due to law changes, regulatory shifts, and state-specific rule revisions
  • Additional related planning (e.g., estate, incapacity, elder care litigation)

Thus, a single client might produce fees year after year — not just a one-time engagement. That shifts your business from one-off transactions to lifetime client relationships.

Scaling effects & margin improvement

Because Medicaid planning relies heavily on systems and processes (calculations, document generation, workflows), the marginal time per additional case drops over time. As the team becomes proficient and uses integrated tools (like STEPS™), your effective hourly rate rises.

Firms that build a pipeline of Medicaid cases often see their profit margins jump 15–25% (versus pure estate planning) because there is less “new legal research” and more trust in repeatable workflows.

Operational advantages: integration, automation, control

Adding Medicaid planning doesn’t have to mean chaos. The firms that succeed do so by embedding it into their systems and technology stack.

1. CRM & client journey integration

  • Track each client’s timeline (e.g. projection of when they’ll cross state eligibility thresholds, trust funding deadlines, look-back windows)
  • Automate reminders for reviews, follow-ups, or documentation updates
  • Monitor where each client is in the Medicaid plan / trust funding lifecycle

This turns Medicaid planning from a “siloed project” into part of a unified client lifecycle.

2. Automated calculation engine

Using software like STEPS™ (or equivalent), you eliminate reliance on manual spreadsheets or ad hoc calculators. Your attorney or staff simply input client data, and the system generates:

  • Eligibility projections
  • Penalty period / look-back assessments
  • Asset protection scenarios
  • Document drafts ready for review

This reduces error, speeds up delivery, and ensures consistency.

3. Document automation and templates

Trust documents, promissory notes, caregiver agreements, QITs, and ancillary documents are generated automatically, with state-specific logic layered in. That means less drafting, fewer custom one-off adjustments, and faster turnarounds.

4. Training, protocols & playbooks

Firms that scale Medicaid planning build standard operating procedures: checklists for intake, risk review, quality control, client education materials, and internal staff workflows. This consistency reduces bottlenecks and ensures smooth handoffs.

Risk mitigation & ethical compliance

Adding Medicaid planning brings regulatory and ethical responsibilities, but good systems mitigate many of those risks:

  • Built-in compliance checks (look-back analysis, disallowed transfers)
  • Audit trails and versioning of calculations and documents
  • Legal updates and rule changes pushed via the software so you never rely on stale rules
  • Client consent protocols and disclosures baked into templates
  • Staff training on jurisdictional differences

Firms that do Medicaid planning well treat compliance as a selling point: “We use tools that safeguard against audit risk and adhere to each state’s statute.”

A pragmatic rollout strategy

Here’s a suggested phased roadmap to adding Medicaid planning:

PhaseFocusKey Actions
Pilot / Proof-of-ConceptSelect a handful of trusted clients or pro bono casesUse STEPS ™ internally, test workflows & document generation
Core OfferingMarket the service to existing clientsBundle Medicaid planning as an add-on or “upgrade” in your estate plan packages
Scale & TrainBring staff or junior attorneys into the processEstablish SOPs, automation, delegation, QC checkpoints
Referral NetworkBuild referral sourcesAlign with CPAs, geriatric care managers, financial planners
Metrics & Feedback LoopMonitor KPIsTrack # of leads, close rates, average fee, recurring revenue, client satisfaction, error rates

Turning Client Need into Firm Growth

As long-term care costs continue to rise, clients are desperate for guidance, and they’re willing to pay for trusted legal expertise that protects what they’ve built. For estate planning firms, that creates both an obligation and an opportunity.

Medicaid planning isn’t just about helping clients qualify for care, it’s about positioning your firm as the go-to advisor for life’s most financially critical transitions. By integrating proven tools like LWP’s STEPS™ software and automated trust drafting systems into your workflow, you eliminate the guesswork, save time, and generate a measurable lift in both efficiency and profitability.

Every Medicaid case you handle builds recurring revenue through annual reviews, refilings, and trust maintenance, while deepening your client relationships and referral base. And with the aging population accelerating, firms that establish a systematized Medicaid offering today will be those best positioned for sustainable, predictable growth tomorrow.

The choice is simple: keep competing in a crowded estate planning market—or stand apart as the firm that helps families protect assets, qualify for care, and plan with confidence.

👉 Explore how Lawyers With Purpose can help you integrate Medicaid planning, automation, and business growth strategies into your practice. Schedule a discovery call today or email info@lawyerswithpurpose.com to learn more.

drafting software actually increase your law firm revenue

Top 5 Medicaid Planning Mistakes Attorneys Should Help Clients Avoid

by Medicaid

For many families, the high cost of long-term care comes as a shock. With the national average for a nursing home room exceeding $8,500 per month (Genworth Cost of Care Survey, 2023), even well-prepared clients can see their life savings vanish in a matter of months. That’s where Medicaid planning steps in as both a safety net and a vital part of comprehensive estate planning.

But here’s the catch: Medicaid planning is full of landmines. One wrong move can delay eligibility, trigger penalties, or even result in a denial that leaves families scrambling to cover care costs. As an estate planning or elder law attorney, your guidance is crucial to steering clients away from these common errors.

Below are the top five Medicaid planning mistakes attorneys should help their clients avoid, along with strategies to get it right.

1. Relying on Outright Gifts to Family Members

Many clients assume that simply giving assets to children or grandchildren will solve their eligibility issues. On the surface, it seems logical: move assets out of the estate, and Medicaid can’t count them.

The problem? Medicaid’s five-year lookback period. Any transfers made within five years of applying can trigger penalties that delay eligibility. Worse, outright gifts expose assets to the creditors, lawsuits, or divorces of the recipients.

Better Approach:
Use tools like an Irrevocable Pure Grantor Trust (iPug®) instead. This allows clients to protect assets, maintain some level of control, and avoid the risks that come with outright gifting. Trust-based strategies also prevent the unpredictability of a child’s financial situation from jeopardizing the family’s security.

2. Waiting Too Long to Start Planning

A common mistake is waiting until a client is already in a nursing home—or on the verge of needing one—before considering Medicaid planning. At that point, options are limited, and families often face a spend-down that could have been avoided.

Better Approach:
Encourage early, proactive planning. By starting well before the need for long-term care arises, attorneys can help clients protect significantly more assets. Even when planning starts late, tools like Medicaid-compliant annuities or promissory notes can still preserve resources—but the earlier the planning begins, the greater the protection.

3. Misunderstanding Medicaid Eligibility Rules

Medicaid eligibility is notoriously complex, and rules vary by state. Clients often misunderstand which assets “count” and which are exempt. Retirement accounts, primary residences, and spousal allowances can all be treated differently depending on the jurisdiction.

Better Approach:
Attorneys should use state-specific tools and software to ensure accuracy. For example, LWP’s STEPS™ software automates Medicaid calculations, identifies protected assets, and clarifies penalty periods—removing guesswork and reducing costly errors. Staying current with state regulations is non-negotiable.

4. Submitting Incomplete or Incorrect Applications

The Medicaid application process is paperwork-heavy, and missing even one document can lead to delays or outright denial. Common missteps include misreporting income, failing to provide proof of asset transfers, or missing deadlines for supplemental requests.

Better Approach:
Implement a systematic application process. Checklists, templates, and dedicated intake systems ensure nothing is overlooked. Attorneys can also educate clients on the importance of keeping organized records well in advance of applying.

5. Overlooking Ongoing Compliance and Recertification

Many attorneys focus only on the initial Medicaid application, but annual recertification is just as critical. Clients who fail to update their information or who inadvertently exceed income or asset limits risk losing their benefits.

Better Approach:
Build recertification support into your workflow. Attorneys can schedule proactive check-ins, use client status dashboards, and provide ongoing guidance to ensure compliance. This not only prevents lapses in eligibility but also strengthens client relationships over time.

How Attorneys Can Get It Right

Avoiding these mistakes requires more than legal knowledge—it requires systems, processes, and the right tools. Firms that excel in Medicaid planning tend to have:

  • Documented workflows for intake, eligibility review, and application prep
  • Centralized task tracking so nothing falls through the cracks
  • State-specific software, like LWP’s STEPS™, that removes guesswork from eligibility calculations
  • Education materials (like the Asset Protection Analysis Letter) that help clients understand the “why” behind the strategy

By pairing strong technical knowledge with proven workflows, attorneys can deliver consistent results while reducing stress on their team.

Final Takeaway

Medicaid planning is one of the most impactful services estate planning attorneys can provide—but it’s also one of the easiest areas for clients to make costly mistakes. By helping families avoid outright gifting, delayed planning, eligibility missteps, incomplete applications, and recertification pitfalls, you can safeguard both their care and their legacy.

With the right guidance—and the right tools—your firm can become the trusted partner clients turn to when navigating the uncertainty of long-term care.

👉 Want to see how LWP’s STEPS™ software helps attorneys streamline Medicaid planning and protect more assets? Schedule a discovery call with our team today.

IRA to MCA: How to Fund a Medicaid Compliant Annuity with a Tax-Qualified Account

by Legal TechnicalMedicaid

While some states consider an IRA to be exempt resource, in most states this type of asset is countable and must be spent down. This may leave clients facing the complicated question of how to best spend down their retirement accounts. If the client chooses to liquidate the retirement account, they may incur sizeable tax consequences. Yet, without eliminating this countable asset, the client’s resources will exceed the limitations to qualify for Medicaid. Utilizing a Medicaid Compliant Annuity can help protect their tax-qualified accounts by preventing immediate taxation of liquidating the account and accelerating their eligibility for Medicaid.

What is a Medicaid Compliant Annuity?

A Medicaid Compliant Annuity (MCA) is a crisis spend-down tool that can help senior clients accelerate their eligibility for Medicaid benefits. The MCA is a Single Premium Immediate Annuity (SPIA) that is structured to adhere to the federal requirements of the Deficit Reduction Act of 2005. By converting their excess countable assets into an income stream, applicants can effectively eliminate assets for Medicaid purposes resulting in their ability to qualify for benefits sooner.

Funding an MCA with Tax-Qualified Funds

One way to avoid the tax consequences of liquidating an IRA is to transfer the funds held in the IRA to a tax-qualified Medicaid Compliant Annuity. The initial transfer to the MCA does not trigger a taxable event for the account owner if the ownership of the accounts remains the same. Instead, they are only taxed on the total distribution payments from the annuity they receive that year. This will allow the account owner to stretch the taxation of the IRA over multiple tax years rather than be assessed all at once.

When funding an MCA with a tax-qualified account, the account owner can do so using either a 60-Day Rollover or a Trustee-to-Trustee Transfer.

60-Day Rollover:

This transfer option is typically more efficient and allows the account owner to maintain more control over the transfer. To complete a 60-Day Rollover, the account owner would contact the IRA custodian company and request a complete liquidation of the account without any taxes withheld. Usually, the account owner can expect to receive the liquidation check within five to seven business days. Once received, the funds will need to be reinvested into a tax-qualified MCA within 60 days to avoid any immediate tax consequences. According to federal regulations, an account owner is limited to only one 60-Day Rollover per 365 days.

Trustee-to-Trustee Transfer:

In contrast, the Trustee-to-Trustee Transfer option is primarily facilitated by the custodian company. This transfer option may take four to six weeks to complete and takes place directly between the plan administrator of the IRA and the insurance company establishing the MCA. To utilize this option, the account owner would complete additional authorization paperwork for the transfer when submitting the MCA application. The insurance company issuing the MCA would then request the funds directly from the custodian company of the IRA. There is no limit to the number of Trustee-to-Trustee transfers that an account owner can complete in a 365-day period.

Medicaid Planning with Traditional IRAs

Using an MCA to protect your client’s IRA can help them avoid large tax consequences and prevent them from entering a higher income tax bracket. By transferring a traditional IRA to an MCA, the account owner can spread the tax consequences of liquidating the IRA over the entire annuity term. As such, the account owner can benefit from structuring the annuity with a longer term to provide a greater economic benefit.

If you have questions about how your client could benefit from using an MCA to spend down their tax-qualified accounts, schedule a Discovery Call with an advisor today!

Post provided by Krause Financial Services.

TAPER Orlando

Building a Firm that Roars in the 2020’s: The Future is Now at TAPER Orlando

by David J. ZumpanoMedicaidNewsletter

At TAPER Orlando, Dave will share his vision for the profitable practice of law in the new decade. His Keynote address will be followed by some of the most transformative breakout sessions we’ve ever hosted. There will be sessions about adding Alzheimer’s planning to your firm; the SECURE Act; a three-part series on the TLC Estate Planning Process; budgeting; ActionStep financial reporting; marketing; VA benefits; and more.