Advice Re: Fee Structure for Medicaid Planning/Crisis Cases

• February 2, 2025 at 12:39 pm #35391
  Jeanette Mullett-Meisel

  Hello fellow elder law attorneys,

  I am looking for insight into how you structure your Medicaid planning, spend-down, and application assistance fees in your practice. Specifically, I’d like to know:

  Do you use flat fees, hourly rates, or a hybrid approach?
  How do you value a case (e.g., based on complexity, assets involved, or anticipated hours)?
  Do you bundle services (e.g., spend-down planning, asset protection, and application filing), or do you price them separately?
  If using flat fees, do you offer different tiers (e.g., Medicaid pre-planning vs. crisis planning)?
  What are some best practices for structuring payments to align with the spend-down process?
  I appreciate any insights you can share on pricing strategies that work well for your firm and clients!

  February 21, 2025 at 12:13 pm #35450
  jacob mills

  For crisis cases, I charge a minimum flat fee of $13,000.

  I do this work mostly in Kentucky and Tennessee, but a little bit in Ohio, too. Would love to connect.

  Jacob M. Mills
  Mills Legal Planning PLLC
  Phone: (859) 559-0186
  Fax: (606) 294-6093
  Email: [email protected]
  Mail: P.O. Box 68, London, KY 40743

  December 3, 2025 at 11:33 am #36468
  Stefan Kolis

  I make most clients hire us for a “Full Case Analysis” for $4,500. This is an investigative service where we issue a report about: 1. Where they are; 2. the relevant Medicaid rules to come into play; and 3. the options i see available to them. At the end of the FCA Presentation (which i give them via powerpoint), I include quotes on the various options, which I have tailored to the client’s goals/options, as well as non-objective variables. This would be issues like: client struggles to get us documents, has a bad attitude, lots of unknown variables we could not resolve in the FCA.

  Most of my Medicaid applications are flat rate ~8-12k, but I do take cases on an hourly basis, often in Married couple situations were we have $ available to replenish the retainer. I often do Married Medicaid application work as 2 parts: 1. Flat rate for Resource Assessment / CSRMA + spend down; 2. Medicaid Application. This way, if the spouse passes during the time, client is not too far into the process.

  I think the system works well because lots of folks just need to know where they stand, and the FCA gives them this. We often end the FCA with a conclusion of: “dont do anything yet, BUT when X happens, call us asap for Y services.” I developed this process after getting burned by just taking medicaid application cases up front with no investigation – we kept finding rotten facts that completely changed the focus of the case. Normally, the FCA helps us nail what the actual goal/priority is. A case might come in as “we want to save as much $ as possible”, and after investigating, we find that the goal needs to be “we need to fix a bunch of penalties so we can pay for care.”