Agenda

1. Medicaid Long-Term Care Eligibility: The Rules That Govern Every Plan

   1. Institutional Medicaid vs. Waiver and Home-Care Pathways, What “Nursing Home Medicaid” Actually Covers
   2. The Four Gates: Income, Resource (Asset), 60-Month Lookback, and Level-of-Care
   3. Countable vs. Exempt Resources and Limits
   4. Spousal Impoverishment: The Community Spouse Resource Allowance (CSRA) and the MMMNA
   5. Transfer Penalties: How Uncompensated Gifts Create a Penalty Period and Why Timing is Everything

2. Ethics in Family-Business Medicaid Planning

   1. Who Is the Client? Conflicts Among the Owner, the Spouse, and the Next-Generation Successors
   2. Capacity, Undue Influence, and Planning When the Owner's Decision-Making is Declining
   3. Confidentiality and Joint Representation in a Family Enterprise
   4. Counseling Boundaries: Lawful Planning vs. Fraudulent Transfer and Misrepresentation to the Agency

3. Pre-Need Planning: Protecting the Business Outside the Five-Year Window

   1. Medicaid Asset Protection Trusts (MAPTs) and How to Fund Them With Business Interests
   2. Entity Restructuring: Recapitalization, Voting vs. Non-Voting Interests, and Gifting Non-Voting Shares
   3. Family Limited Partnerships and LLCs as Planning and Consolidation Vehicles
   4. Coordinating With Buy-Sell Agreements and the Existing Business Succession Plan
   5. Retained-Income and Retained-Control Traps That Pull Assets Back Into the Countable Estate

4. Crisis Planning: Saving the Business When the Nursing Home Is Imminent

   1. Spend-Down Done Right: Converting Countable Assets to Exempt Without Wasting Value
   2. The “Half-a-Loaf” Gift-and-Promissory-Note Strategy and Medicaid-Compliant Annuities
   3. Protecting the Community Spouse Who Runs or Depends on the Business
   4. Personal Services/Caregiver Agreements Involving the Business and its Payroll
   5. Sequencing and Documentation: Building a Record That Survives Agency Review and a Fair Hearing

5. Why Business Owners Are Different: Countable, Exempt, and the Self-Support Question

   1. How Medicaid Characterizes a Business Interest: Active Trade or Business vs. Passive Investment
   2. The “Property Essential to Self-Support” Exclusion: When an Operating Business is not Counted, and Its Limits
   3. Valuing Closely-Held Interests: Minority and Marketability Discounts, and What the Agency Will Scrutinize
   4. Income Attribution: Salary, Guaranteed Payments, K-1 Pass-Through Income, and Distributions
   5. Special Cases: Family Farms, Professional Practices, Real-Estate Holding Entities, and Sole Proprietorships

6. Income, Distributions, and Keeping the Business Running

   1. Restructuring how the Owner is Paid to Preserve Income Eligibility
   2. Qualified Income (Miller) Trusts in Income-Cap States
   3. Operating the Business During Institutionalization: Management, Authority, and Powers of Attorney
   4. Coordinating Distributions With the Community Spouse's Income Allowance

7. Tax Traps, Estate Recovery, and Multidisciplinary Coordination

   1. Lifetime Transfer vs. Step-up in Basis: The Capital Gains Cost of “Protecting” the Business too Early
   2. Medicaid Estate Recovery Exposure on Business Assets and How to Limit It
   3. Working With the CPA, Financial Planner, and Business Attorney: Who Owns Which Piece
   4. Building a Written, Defensible Plan the Family and Successors Can Actually Execute