What does an elder law attorney do?▾
Elder law attorneys specialize in legal issues affecting older adults: Medicaid planning, powers of attorney, advance directives, guardianship, estate planning, and nursing home contracts. A comprehensive elder law plan typically costs $3,000–$8,000 but can save tens or hundreds of thousands of dollars in Medicaid penalties or improper care contracts.
When should I set up a power of attorney for my parent?▾
As soon as possible — ideally before any cognitive decline. A POA can only be created while the principal has legal capacity to understand and consent. Once a person is incapacitated, the only option is a court-appointed guardianship or conservatorship, which is significantly more expensive, slower, and invasive.
What's the difference between a healthcare POA and a living will?▾
A healthcare power of attorney names a specific person (the agent/proxy) to make medical decisions on your behalf. A living will (advance directive) records your personal wishes about specific treatments — CPR, ventilators, feeding tubes, and hospice. Both are recommended: the POA handles situations the living will didn't anticipate, while the living will guides the agent's decisions.
What is a Miller Trust and when is one required?▾
A Miller Trust (Qualified Income Trust) is a legal tool required in income-cap Medicaid states — like Texas, Florida, and Arizona — when monthly income exceeds the state threshold ($2,901/month in 2025). Excess income is deposited into the trust each month, and Medicaid covers the care cost remainder. Without a Miller Trust in a cap state, an applicant over the income limit will be denied Medicaid regardless of assets.
Can I do Medicaid planning without an attorney?▾
Simple Medicaid applications are possible without an attorney in straightforward cases (income and assets already below limits). However, any situation involving a Miller Trust, irrevocable trust, penalty transfers, spousal asset protections, or complex assets requires an elder law attorney. A $2,000–$3,000 attorney fee almost always pays for itself by preventing Medicaid penalties worth far more.
What happens if my parent becomes incapacitated with no POA?▾
Without a valid POA, family members cannot legally access bank accounts, sign care agreements, or make financial decisions on a parent's behalf. The only remedy is a court-ordered guardianship or conservatorship — a process that takes 3–6 months, costs $3,000–$10,000 in attorney fees, and requires ongoing court reporting. Setting up a POA while a parent still has capacity avoids this entirely.
How does the Medicaid 5-year look-back rule work?▾
When applying for Medicaid nursing home coverage, the state reviews all asset transfers made within the preceding 60 months (5 years). Any gifts or transfers below fair market value create a penalty period during which Medicaid will not pay — calculated by dividing the transfer amount by the state's average private-pay nursing home cost (the 'penalty divisor'). For example, a $90,000 gift in a state with a $9,000/month divisor creates a 10-month penalty period.
What is the difference between a revocable and irrevocable trust for Medicaid?▾
A revocable living trust does not protect assets from Medicaid — because you can take the assets back, they remain countable. An irrevocable Medicaid trust permanently transfers assets out of your control and out of your Medicaid-countable estate, but only after the 5-year look-back period has passed. Irrevocable trusts require careful drafting by an attorney and cannot be undone.
