Get Medicaid Planning Help Am I Eligible? Start Your Medicaid Eligibility CheckStart by answering the following questions to see if you qualify and to uncover the most practical and affordable options for Medicaid planning support. Some advisors offer their help at no cost, while others charge for their services. Not every professional will be the right fit, so this form is designed to point you toward the option that best matches your situation. Important: This form is only for older adults, age 65 and above, who are exploring Medicaid long-term care benefitsPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Who needs Medicaid benefits? *YourselfYour ParentYour SpouseYour ClientOtherIs the person applying for Medicaid single or married? *SingleMarriedWhere does the applicant currently live? *At HomeA Family member's HouseAssisted LivingTemporary RehabPermanent Nursing Home Care couple the does What is the age of the applicant? *Under 65 (not disabled)Under 65 (disabled and receiving SSDI)65-85Over 85Why is the applicant applying for Medicaid? *Home CareAssisted Living CareNursing Home CareDoes not require long-term careIs the applicant a veteran or widow/widower of a veteran? *Non-Wartime Veteran/ SpouseWartime Veteran/ SpouseNot a veteranWhat is the total monthly income of the individual applying or couple (if both are applying)? *Less than $1,250 per month$1,250-$1,750 per month$1,750-$2,850 per month$2,850-$5,700 per monthOver $5,700 per monthDoes the applicant have a life insurance policy? *No life insuranceLife insurance with a Cash Surrender Value (CSV) less than $1,500Life insurance with a CSV between $1,500-$10,000Life insurance with a CSV over $10,000Life insurance with an unknown CSVDoes the applicant own a home? *No, they do not own a home.Yes, equity is less than $200,000Yes, equity between $200,000-$713,000Yes, equity is between $713,000-$750,000Yes, equity is between $750,000-$1,071,000Yes, equity is over $1,071,000What are the total financial assets of the applicant (not including residential home)? *Less than $2,000$2,000-$5,000$5,000-$10,000$10,000-$20,000$20,000-$35,000$35,000-$50,000$50,000-$150,000Over $150,000What is the applicant's estimated monthly expenses? *Less than $2,000$2,000-$3,000$3,000-$4,000Over $4,000UnknownWhat State does the applicant live? *What County does the applicant live? *What benefits/coverage does the applicant currently have? Check all that apply. *Medicare/Medicare Advantage PlanLong-Term Care MedicaidRegular (ABD) MedicaidVeterans PensionSocial Security DisabilityNone of the aboveHow soon does the applicant need Medicaid? *ImmediatelyWithin 3 MonthsOver 3 MonthsIs the applicant considering applying in a different state? *YesNoName *FirstLastEmail *Phone Number *Submit
