Your father has been diagnosed with Alzheimer’s. His savings will last about eighteen months in residential care. A friend tells you to call a Medicaid planner. Another friend says to hire an elder law attorney. A flyer arrived in the mail promising to protect the house from Medicaid for a flat fee of $3,995. You do not know who to trust, and you are running out of time.
This is the confusion we want to clear up. The two professions overlap in what they promise, but they differ sharply in what they can legally do, who regulates them, and what happens if something goes wrong.
Start with what Medicaid planning actually involves
Before comparing the professionals, it helps to understand what the work looks like. Our Medicaid planning guide covers the strategy in depth, but at a high level it is a mix of the following.
Reviewing five years of financial records to identify transfers that could trigger a penalty period under the Medicaid lookback rule. The federal rule is codified at 42 U.S.C. 1396p and every state applies it.
Restructuring assets so the applicant legally falls under the state’s resource limit without giving away everything. This may involve spending down, annuities, spousal protections, caregiver agreements, or, in some states, irrevocable trusts.
Preparing and filing the Medicaid application itself, which in most states runs forty or more pages and requires documentation going back years.
Representing the family if the application is denied, which usually means an administrative fair hearing.
Some of this is legal work. Some of it is clerical. Some of it is financial strategy. The question is who is allowed to do which parts.
What an elder law attorney does
An elder law attorney is a licensed lawyer whose practice focuses on issues affecting older adults and people with disabilities. Their work includes Medicaid planning, but also estate planning, trusts, powers of attorney, advance directives, guardianship, nursing home rights, special needs planning, and litigation when things go wrong.
Because they are lawyers, they can do things no one else can legally do.
They can give you legal advice, meaning they can tell you what a specific action will mean for your specific situation. They can draft legal documents including irrevocable trusts, deeds, promissory notes, personal services contracts, and powers of attorney. They can represent you at a Medicaid fair hearing, in probate court, or in a guardianship proceeding. And they owe you a fiduciary duty, which means their legal and ethical obligations run to you, not to a product they are trying to sell.
The best-credentialed elder law attorneys are members of the National Academy of Elder Law Attorneys (NAELA), the professional association that publishes practice standards and runs continuing education. A smaller number hold the Certified Elder Law Attorney (CELA) credential from the National Elder Law Foundation, which is accredited by the American Bar Association. CELA certification requires five years of practice, substantial elder law experience, peer references, and a written exam. Fewer than 500 attorneys nationwide currently hold it.
What a non-attorney Medicaid planner does, and does not do
“Medicaid planner” is not a regulated title in most states. The people who use it come from different backgrounds. Some are former social workers or hospital discharge planners. Some are financial advisors or insurance agents, often ones who sell Medicaid-compliant annuities. Some have no relevant credential at all.
What they can legally do varies by state, but generally includes gathering documentation, filling out the Medicaid application, calling the caseworker, and helping the family spend down in straightforward ways (paying off debts, prepaying funeral expenses, buying exempt items).
What they cannot legally do, in most states, is the work that requires a law license. The American Bar Association and many state bars have taken the position that drafting trusts, advising on the legal effect of asset transfers, or representing a client at a fair hearing constitutes the unauthorized practice of law when done by a non-attorney. Several states have prosecuted non-attorney planners for exactly this, and the Department of Veterans Affairs imposes its own accreditation requirement on anyone helping with VA benefits. This is one reason we flag non-attorney planners as a caution in our guide to VA Aid and Attendance.
The practical risk is this. A non-attorney planner sells you a strategy involving a trust. The trust is drafted by someone without legal training. Years later the Medicaid caseworker rejects it, or a family member challenges it in probate, or the IRS treats it differently than promised. There is no malpractice insurance, no state bar grievance process, and often no one left to hold accountable.
When the cheaper route is fine
Not every family needs an attorney. If your parent has modest assets (well under the state Medicaid limit), no home, no spouse still living in the community, and no transfers in the past five years, the case is simple. The application is the work, and the application is not legal work.
In that situation your best free resource is your State Health Insurance Assistance Program (SHIP), which offers free Medicare and often Medicaid counseling in every state. Your local Area Agency on Aging can also help, sometimes sitting with you to complete the paperwork at no cost. The state Medicaid office itself will often accept applications and answer questions by phone.
For simple cases, a non-attorney planner or a free public program can be enough. The trouble starts when the situation is not simple.
When you really need an elder law attorney
You should not try to save money on legal help if any of the following apply.
Your parent owns a home and you want to protect it from Medicaid estate recovery. The rules on the homestead exemption, transfer penalties, and estate recovery vary sharply by state, and a wrong move can cost hundreds of thousands of dollars.
Your parent is married and the non-applicant spouse will continue living in the community. Spousal impoverishment protections are valuable, complicated, and easy to apply incorrectly, as our Medicaid pays for residential care guide explains in more detail.
There have been gifts or transfers in the past five years. Even transfers made with no Medicaid intent, such as helping a grandchild with college, can trigger a penalty period. Correcting for this requires legal strategy.
You are being told to use an irrevocable trust, a personal services contract, or a Medicaid-compliant annuity. All of these are legal instruments with real tax and legal consequences. A non-attorney cannot draft them properly. Our guide on what happens when the money runs out mid-stay walks through when these tools get used and when they do not.
The application has been denied and you are heading to a fair hearing. You want a lawyer for that conversation.
There is family conflict, a blended family, or a disabled child who needs a special needs trust.
You live in a state that has aggressively prosecuted non-attorney Medicaid planning, including Florida, Pennsylvania, Ohio, and Tennessee.
What it costs
Elder law attorneys charge either by the hour or by flat fee. Hourly rates run $300 to $600 depending on the market. Flat fees for defined projects are common in this practice area.
Typical 2026 flat fees look like this. A simple power of attorney and advance directive package runs $500 to $1,500. A basic estate plan with a revocable trust runs $2,500 to $5,000. Comprehensive Medicaid planning, including asset analysis, trust drafting if appropriate, and application support, commonly runs $5,000 to $12,000. A contested fair hearing or guardianship is billed hourly and can reach $10,000 or more.
Non-attorney planners often advertise lower fees, sometimes $2,000 to $5,000 for Medicaid planning. The fee may look attractive, but remember that it may not include the document drafting you actually need, and it carries the risk we described above.
Compared to the cost of care, either professional fee is small. A single month of residential care commonly costs $6,000 or more, as we cover in our article on how much board and care costs. Getting Medicaid eligibility right even one month earlier usually pays the entire legal fee.
How to find a good elder law attorney
Start with the NAELA member directory. Filter by state and, if possible, by CELA certification. Read the attorney’s bio and look for specific mention of Medicaid planning and residential care, not just estate planning.
Ask your local Area Agency on Aging for referrals. They see which attorneys actually close cases for their clients and which do not return phone calls.
Interview two or three before hiring. Ask: What percentage of your practice is Medicaid planning? How many applications did you file last year? What is your flat fee for a case like mine, and what does it include? Who does the work, you or a paralegal? Do you represent clients at fair hearings?
And ask the uncomfortable question directly. Do you receive any commission or referral fee from annuity products, life insurance, or any other financial product you may recommend? The answer should be no. If it is yes, you are talking to a salesperson with a law license, not an independent advisor.
A word on free seminars
You will see advertisements for free dinner seminars on “protecting your home from Medicaid” or “avoiding nursing home poverty.” Some are legitimate community education hosted by law firms. Many are lead generation events for annuity sales, and the pressure tactics can be intense. AARP and state attorneys general have warned repeatedly about these events. Go if you want, eat the chicken, take the handout, but do not sign anything in the room.
Your next step
If your family situation has any of the complications we listed (home, spouse, transfers, denied application, conflict), go to the NAELA directory today and schedule consultations with two CELA-credentialed attorneys in your state. Most offer a free or reduced-fee initial consultation. Bring five years of bank statements, the deed to any real estate, and a list of your questions. You will know within one meeting whether the attorney is the right one. If your case is simple, call your state SHIP office instead and let them walk you through the application for free.