Get Started

"*" indicates required fields

Which activities of daily living does your loved one require assistance? (Please check all that apply):*
Does your loved one have mental capacity to sign legal documents?*
Is there a General/Financial Power of Attorney in place?*
*Has the individual seeking Medicaid (or his or her spouse) given away any money or property within the last 5 years?*
*What does this include?
  • -Property sold for less than fair market value;
  • -Property or money (over $1,000) given away to any individual(s);
  • -Property or money transferred to an irrevocable trust;
  • -Any money loaned to someone that was not paid back;
  • -Bills (other than their own) paid on someone else’s behalf (ex: Medical Bills, Utilities, Rents, Premiums, etc.);
  • -Property that individual’s name was removed from title (such as a home or vehicle);
  • -Property purchased for someone else (such as a home or car).
Congratulations! You’ve taken an important step in seeking financial assistance for your loved one’s long-term care. Please enter your contact information, and someone from our office will reach out to schedule a consultation, where we will discuss Medicaid eligibility and provide options for moving forward.
Name*