Medicaid Savings Calculator Step 1 of 3 33% Please take a couple minutes to see how much you could save in nursing home costs. After you complete this form you will have an opportunity to schedule a consultation with our law firm.Is the medicaid applicant single or married?* Single Married (Only One Spouse In or Entering a Nursing Home) Married (Both Spouses In or Entering a Nursing Home) Monthly income of Medicaid applicant*Monthly income of Medicaid applicant’s spouse*Monthly private pay cost of the nursing home that the applicant is in or expected to go in one shortly?*Please enter a number from 0 to 30000.Monthly private pay cost of the nursing home that the spouse is in or expected to go in one shortly?*Does applicant (and/or spouse, if married) own a home in Hawaii?* Yes No What is the fair market value of the home?*What is the outstanding mortgage, home-equity line of credit & any liens?*Are there any other owners other than applicant (and spouse, if married)?* No Yes HiddenHome Fully OwnedPlease enter a number from 1 to 100.What percent does the Medicaid applicant (and/or spouse, if married) own?*Please enter a number from 1 to 100.Check all that apply Applicant has a minor child (under age 21) Applicant has a blind or disabled child Applicant has a sibling (brother or sister) who has lived in the same home as applicant for at least 1 year before applicant went (or will go) to nursing home Applicant has an adult child who has lived in the same home as applicant for at least 2 years before applicant went (or will go) to nursing home Does applicant (and/or spouse, if married) own any other real estate anywhere? Yes No What is the total market value of all properties (other than primary residence)*What is the outstanding mortgage balances of all properties (other than primary residence)*What is the total net worth of all of your other assets? (Include assets of spouse if married)Include checking account, savings, CDs, stock bonds, mutual funds, IRAs, 401ks, cash value of life insurance & annuity, but excluding vehicles.Any debts other than mortgage, home-equity line of credit or lien on primary residence or any other other real estate.Total estimated value of all gifts & donations made by you (and/or spouse, if married) over the last 5 years.Rough estimate ok. Ignore small birthday or Christmas gifts you normally give.HiddenAssets ValueApplicant & spouses assets - debts (excluding primary home debts)HiddenApplicant in Nursing HomeHiddenSpouse in Nursing HomeHiddenTotal in Nursing HomeHiddenHouse Value - Someone Living In ItHiddenSpouse In NH Months DivisorHiddenNumber of MonthsHiddenNegative Number of MonthsHiddenPositive Number of MonthsHidden60+ Number of MonthsHiddenAdj Num of MonthsHiddenAmount Returned For Care Total SavingsCongratulations! Based on the information you provided, we can likely save and protect about this much of your assets:Total SavingsCongratulations! Based on the information you provided, we can likely save and protect about this much of your assets:Congratulations! Based on the information you provided, One spouse can likely get qualified for Long-Term Care Medicaid, while protecting the assets for the other spouse who is living at home. Thanks for completing this form, please provide your name and number so we can schedule your FREE consultation.Name* First Last Phone*Email* NotesFeel free to add any additional information in this Notes section (optional) Δ
