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Medicaid and Long Term Care Planning Attorney

A Medicaid and Long Term Care Planning Attorney can help individuals and couples qualify for Medicaid or the VA Aid and Attendance Pension Benefit often with the goal of preserving assets. Nearly one in two women and one in four men find themselves in a long-term care facility at some point in their lives, which can mean not only great loss of personal autonomy but also tremendous financial burden. Depending on location and level of care, long term care cost can exceed $100,000 a year.


Long-term care is In Home Care, Adult Family Home Assisted Living, or Skilled Nursing (the highest level of care). If you pre-plan you can be sure to keep all of your options open but if you spend down your entire estate you will be pigeon holed into one or two facilities. Preserving some of your estate will provide you with the choice of where you reside, whether that is in your own home with in home care, or a residence facility of your choice. Preserving part of your estate will improve the quality of your life as you grow older. Remember, Medicaid does not pay for everything; you will need your own finances if you want things like a second pair of glasses or a private room.

A common thing we hear is, “My husband has been in the nursing home for two years, I have liquidated everything and now I am broke, how can you help me?” We often see a family that has spent down all of their assets on a high quality of care until they are broke. The facility they are in then has the potential to kick them out and into a place of much lower quality where they are left with no choices.

Before you start to liquidate and spend down your assets we can help. Once you are broke your only choice is Medicaid. Many facilities do not accept Medicaid and many that do accept it require a private pay wait period. Funds can be depleted very quickly; an elder law attorney will work with you to strategize asset preservation and planning to get government benefits before you become impoverished.

Depending on your family’s priorities, how your assets are held and how much we need to strategize to preserve, we can help you to qualify for government benefits while preserving the estate for the well spouse or the person on benefits. Some of those strategies include:

  • Complex Trust Drafting
  • Gifting: We ask Medicaid to impose a penalty against us for gifting, and then use that period to our advantage to purchase exempt resources such as homes or vehicles.
  • Annuity: A Medicaid compliant annuity to create a source of income for the well spouse and preserve the estate. Medicaid annuities are very complex with many statutory rules.
  • Transferring Assets out of the ill spouse’s name.
There are four ways to pay for long-term care:

Private Pay
Long-Term Care Insurance
Veteran’s Aid & Attendance Pension Benefits

We specialize in the two government programs that are available to help pay for long term care, Medicaid and the Aid and Attendance Pension Benefit. For both there is an asset or resource requirement, an income requirement, and a medical need requirement. You have to meet all three, and that is where we come in.

For someone that is over resourced or over income, know what your options are before you start to liquidate assets. Know that you have choices, you can strategize, but the planning is very complex. There are complex rules even with gifting that you need to know about. The laws are changing all the time, in fact the laws can change every quarter.

“Holland is a great listener and lawyer. When we came to her with our needs, she thoughtfully listened, was helpful with all our questions, and then explained our options. Her sense of humor helped us through some long waits with the system. In the end, we ended up with a surprisingly favorable settlement and a good friend in the courts.”



The cost of long-term care has risen significantly in the past decade, and will continue to rise. The average cost of an assisted living facility in Washington State is $5,000.00/month, and a nursing home runs about $10,000.00/month.

One way to pay for this cost is Medicaid. Medicaid is a social health program for low income individuals. Since the cost of care continues to rise, many people find themselves depleting resources to pay for care. The problem is they will soon become impoverished With the right planning, our office can assist seniors in obtaining this benefit while preserving their assets.

There are two types of planning opportunities when qualifying for Medicaid: Pre-Planning and Crisis Planning.


Medicaid has a five year look back period, so it is important that you take the steps necessary to preserve your assets, even if you are perfectly healthy, as soon as possible. If you are thinking about preparing for the possibility of needing long-term care in the future, you should contact an attorney to advise you and guide you through the process. Not consulting an attorney exposes you to misinformation that could lead you to do something that could disqualify you from Medicaid altogether.

Our office can assist you in reviewing your assets and income and creating a long-term care plan that utilizes legal and ethical strategies to preserve your assets and get you qualified for Medicaid.

Crisis Planning

If you find yourself or your aging parent in need of long-term care immediately, than your case would be considered a ‘crisis case’. This means there are certain strategies that cannot be used because the benefit will be needed sooner than the five year look back period. It is important to consult an attorney immediately, because there are still many strategies that can be implemented to qualify you for Medicaid without going broke. Even if you don’t have the five years to pre-plan, we can still help preserve some of your assets and qualify you for Medicaid.

Our office can evaluate your situation and make the correct recommendations to get you qualified sooner rather than later, and guide you step by step through the whole process.


Long term care planning is an extremely complex process that can be overwhelming. You want a team backing you up and helping with all of the strategies and planning. Our team will ensure that the correct planning is put in place so that you are qualified as soon as possible for the benefit programs. Typically time is of the essence and if you have an attorney you can expedite the process. Every month that there is a delay in qualifying for Medicaid or Aid and Attendance is potentially a lot of money out of your pocket. Medicaid rules can change every three months and the VA has made the Aid and Attendance process so complex that many applications are denied, and often denied without cause.

  • Plan for your parent’s future.
  • Get qualified for Medicaid.
  • Learn how to pay for long term care without going broke.
  • Find a facility that is safe and comfortable.
  • Find a facility that you want to be in, not one that you are forced into because of lack of choice.
  • Your loved one needs to be moved into a facility and you are afraid they are going to lose everything.

If you have an attorney who is familiar and skilled in Medicaid and VA Benefits you can avoid unnecessary delays and potentially save many thousands of dollars.


In a culture that often brushes seniors aside, we have a team of attorneys, paralegals and administrative assistants to help. Our team is devoted entirely to the complexities of long-term care planning and keeping up with the frequent changes in rules.

Our office takes a holistic and hands on approach to planning. We help seniors and their families with all of their needs. We are not just doing a will or an estate plan, we are looking at all of the issues seniors face. What sets us apart is that we take a team approach. Everyone in our office is passionate about helping seniors and we have a unique perspective and appreciation for the difficulties of the process of getting old and dying.


A mother and daughter came to our office. Mother was a senior with need for assistance with activities of daily living. Daughter was providing extensive in home care for the mother so that she could reside in her home as long as possible. When they came to our office the daughter said to us, “I can’t afford it anymore, I can’t take care of my mom.” ” I need to go get a job.”

The mother was the surviving spouse of a veteran. We were able to get this family the resources they deserved. We put together a ‘personal care contract’ and applied for the Veterans benefit. The ‘personal care contract’ was for the daughter to officially provide in home care for the mother. We applied for the VA benefit for the mother and we were able to get cash for her as a surviving spouse of a veteran. She now receives the benefit every month tax free, and is able to use it to pay her daughter for providing care. This was a huge success for the family and accomplished all of their goals. It was their shared goal to keep the mother in the home for as long as possible. Now the daughter is able to afford to continue providing in home care and the mother is able to stay at home.

Another recent client qualified for the Aid and Attendance Benefit of approx. $2200 per month. Because they did not have an accredited attorney, they had been denied four times over the past four years. As a result they had missed out on four years of benefits (approx. $105,600). They were getting information from a non-VA accredited attorney who was not trained or updated on the VA rules. As a result they were inappropriately denied.

We were able to get them approved in less than three weeks.

They had submitted applications that they thought would be approved, but were denied because they did not have the necessary knowledge and were not getting correct information from an accredited attorney. If they had sought an attorney early they would not have missed out on these benefits for the past four years. Unfortunately, they lost out on over $100.000 but they were so happy that we were able to help.

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621 W Mallon, Suite 306
Spokane, WA 99201
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Business Phone: (509) 325-5222
FAX: (877) 331-5798




MAKING A DIFFERENCE in the community and helping people were two reasons Holland McBurns became an attorney. Evergreen Elder Law focuses on estate planning, probate and assisting clients and their families with accessing long-term care benefits without going broke. Holland takes a team-centered and holistic approach to helping families resolve these issues.

Because elder law requires great attention to detail and follow through, Holland receives the most satisfaction from her work when she has successfully helped a family achieve a happy resolution to their legal issue. Recently, Holland has authored a book on elder law and estate planning in Washington State using her vast knowledge and experience in this area of the law. As a way to give back to the elderly community she intends to disseminate this for free in the hopes that is will help people better understand their options as they think about their long-term care and estate planning goals.

To help more people, Holland has grown her team of staff to seven, including another attorney, legal assistants, paralegals, a firm administrator, and a client engagement specialist. “I am proud of the team we have been able to recrnit,” says
Holland. “With such an exceptional team, we are able to provide our clients with equally exceptional services and results. It is beyond satisfying to be able to work alongside them and to offer our clients unparalleled service.

Caring Transitions of Spokane Interview (audio)

Host Michael Begley, owner of Caring Transitions of Spokane, speaks with Holland McBurns. Holland is an Elder Law attorney at Evergreen Elder Law in Spokane. She is accredited with the Veterans Administration to help clients receive their Aid & Attendance Benefit and can help clients preserve their assets when dealing with Medicaid. Furthermore she works on cases related to probate, estate planning and long term care. Don’t miss this podcast, there is a lot of great information.

Alzheimer’s Awareness Month: The Costs of Dementia

November was Alzheimer’s disease and Awareness month. It’s the perfect time to educate people about the disease of Alzheimer’s (and other dementias) and the effects of the disease on its victims and their loved ones. In this edition of the ElderCounselor™, we are going to focus on the high costs associated with dementia during the final years.

read more…

Veteran’s Benefits for Senior Veteran’s and Surviving Spouses

There is a little known benefit available to Veteran’s and their surviving spouses to help pay for long-term care. This is the Aid and Attendance Pension benefit which is a cash benefit that is tax free. Why is this benefit important? Many seniors today are faced with the ever-rising cost of long-term care and the question is how will they be able to pay for care without going broke. In Washington State, longterm care costs continue to rise each year. For example, Assisted living costs are often well above $4,000 a month depending on the particular needs of the senior. Skilled Nursing facility monthly costs are peaking at often over $9,000. Many seniors find themselves selling their homes and depleting their assets in order to pay for care for themselves or their ill spouse. The Aid and Attendance Pension benefit can help. This monthly cash benefit is available to Veterans and their surviving spouses to help pay for and offset the continued rising costs of long-term care.

While the VA offers a plethora of benefits, such as home loans and burial benefits, the Pension Aid and Attendance benefit is a specific benefit for seniors who need help paying for long-term care. One of the often misunderstood things about this benefit is that the veteran does not need to have a service related illness or injury.

There are however certain criteria that must be met in order to be eligible for this benefit. First, the veteran must have served 90 days of active duty and one of those days must have been during a period of conflict. The periods of conflict are as follows:
WWII: 12/7/1941 – 12/31/1946
Korea: 06/27/1950 – 12/31/1955
Vietnam:08/05/1964 – 05/07/1975
Persian Gulf: 08/02/1990 – Present

Although one of the 90 days must have been during a period of conflict, it does not need to be in country, the veteran must simply have been enlisted and in active duty. Second, the veteran must have a discharge other than ‘dishonorable’.

In addition to the time in the military, the veteran or surviving spouse must meet the medical test. This includes needing assistance with at least some of the following: bathing, toileting, general hygiene, meal preparation, medication management, transferring, and transportation. Most seniors with high costs of care already satisfy the medical test.

The final qualifications are that the veteran or surviving spouse must meet an asset and income test. The asset test is a complex formula that takes into account all of the ‘countable’ assets that the veteran or surviving spouse owns at the time of application and their life expectancy. Determining whether you qualify for the asset and income part of the test can be complex and difficult to understand. An accredited VA elder law attorney should be consulted.

Satisfying the income test considers your gross income minus your medical expenses. The resulting figure is considered your income for VA purposes. The veteran or surviving spouse must have high recurring medical expenses to qualify. For example, If a surviving spouse has income from social security and a pension that total $3,000 a month, and needs to reside in an assisted living facility with a monthly cost of care at $4,000, the surviving spouse has an ‘income’ for VA purposes of -$1,000 and would satisfy the income part of the test. Typically, the need for longterm care will always satisfy this income test for VA purposes.

If you think you have too much income or assets, do not be mistaken. Determining which assets are countable and how many you can have can be complex and confusing. There are also many strategies that can be utilized to qualify for both the income and asset part of the test. We recommend that you always speak with a VA accredited elder law attorney to see if you qualify for this cash benefit.
The cash amounts are paid directly to the veteran or surviving spouse on a monthly basis for the remainder of their lives. This cash benefit is also tax free. The total benefit received is often substantial, particularly when added up over a lifetime. The monthly cash benefit amounts for 2015 are as follows:
Veteran’s Pension: $1,788
Veteran’s Pension with one dependent: $2,120
Surviving Spouse: $1,149

The benefit continues for life and can have a huge impact on the level and quality of care for senior veterans or their spouses. For example, if a veteran qualified for the Aid and Attendance benefit with one dependent and is in long-term care for the next 5 years the total amount received would exceed $125,000. Too many veterans and/or surviving spouses don’t take advantage of this benefit because either they don’t know about it or don’t understand the complex qualifications.

The VA Aid and Attendance benefit can be difficult to navigate and determine if you actually will qualify, but it is an incredibly underutilized resource that more veteran’s and their surviving spouses should take advantage of. Consulting with a VA accredited elder law attorney is the best way to find out how to obtain this cash benefit. Don’t delay. This cash benefit could help prevent your family from going broke paying for long-term care.



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