Series Introduction Spenddown

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 essential differences between Maryland and the District of Columbia.

• Crisis versus pre-crisis planning: when planning occurs during a care crisis versus earlier in the diagnosis stage, and how strategies differ.
• Eligibility requirements: medical and financial criteria for long-term care Medicaid, including activities of daily living and asset limits.
• Maryland and D.C. differences: resource thresholds, retirement accounts, home-equity rules, waivers, and estate recovery.
• Spend-down strategies: converting countable assets into exempt assets through debt payment, home improvements, vehicle purchases, and prepaid funeral arrangements.
• Single-applicant planning: promissory notes and gift-and-loan combinations used during crisis planning.
• Married-couple planning: Medicaid-compliant annuities and community-spouse resource protection.
• Transfer rules: the five-year look-back period, penalty calculations, and permitted transfers.
• Asset-protection tools: life-estate deeds, caregiver-child exceptions, and Maryland ABLE accounts.

The presentation emphasized analyzing both front-end benefit eligibility and back-end estate-recovery exposure.