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Asset Protection
Questionnaire
 Our
Asset Protection Questionnaire opens in Adobe Acrobat. Don't have the software on
your computer? Click on the Adobe icon below and follow the instructions to
download the Adobe Acrobat Reader to your computer.
After you open the Questionnaire, click on
the Save button and save it to your computer. Use the Typewriter
function to fill it in, save and print.
Asset Protection Questionnaire
Purpose
The purpose of our
questionnaire is to gather information relevant to the rules and
regulations of the Florida Medicaid Institutional Care Program. Our planning also
includes what happens after the death of our client or spouse.
Information
gathering process - your job as our client
Fill out the questionnaire as
accurately as possible. Charlie's advice depends on a complete
understanding of your situation.
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List all sources of income.
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List and value all assets.
- List all gifts in the past 60 months.
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Provide personal information.
- Provide information about estate planning.
Education
process - Charlie's job
- Determine assets that the Florida Department of Children and Families
(DCF) considers
as available assets.
- Provide strategic information about how to make available assets
unavailable within the DCF regulations.
- Add up available assets.
- Determine income qualification and, if
necessary, explain Qualified Income Trust.
- Make experienced recommendations about actions necessary to qualify
for Medicaid.
- Review and recommend actions regarding estate planning.
Asset Protection Questionnaire
Frequently
asked questions
We realize that our questionnaire looks long and complicated. Not every
asset type may apply to you. Only complete the sections that apply to you.
If you have a question not addressed below, call our office for help.
How does your
questionnaire differ from the financial information questionnaire I filled
out for my broker?
Your accountant, your broker, and other financial advisors are concerned
with tax issues. Our questionnaire is geared to Medicaid rules which are
entirely different from tax laws.
How do I find all the
assets?
Current bank or brokerage account statements and your tax returns are a
great source of information. Your accountant, your broker, and your
financial institutions should also be able to help.
What if I don't know
what type of assets are listed on my statement?
Put the balance of your brokerage account statement on the Questionnaire,
or put a question mark (?) if you don’t know, or put “no” for none. Do
not itemize the individual securities.
Who is the client?
Generally we consider the person who is either in the nursing home or who
soon may be there as the client. If both client and spouse are well, we list the
husband as the client. The key is to be consistent throughout the
questionnaire.
What do you mean by a
transfer for less than value?
Any gift or transfer of an asset for which you did not receive equal value
in return is a transfer for less than value. List all transfers in the
past 60 months so that Charlie can determine how they will affect Medicaid
qualification.
Asset
Protection Questionnaire |
