For many estate planning practices, Medicaid planning is seen as a “nice to have” add-on. But the firms that treat it as a core revenue stream are the ones that outperform their peers. By positioning Medicaid planning (and integrated trust strategies like iPug®) as a standard service line, your firm can capture more cases, generate recurring fees, and deepen client retention.
In this post, we’ll dig into hard numbers, operational levers, and a roadmap for turning Medicaid planning into a growth engine for your practice.
The market is enormous — and growing
- In 2022, the U.S. spent over $415 billion on long-term services and supports (LTSS). Medicaid covered more than 61% of that total. KFF
- Long-term care costs continue to soar: between 2023 and 2024, the median cost of a private nursing home room rose ~9%, assisted living rose ~10%, and in-home care also increased. Berger Estate & Elder Law P.A.
- The global elder law / senior-services legal market is projected to double from ~USD 3.6 billion in 2023 to ~USD 7.2 billion by 2033. DataHorizzon Research
- Many clients mistakenly believe Medicare will cover long-term care. In reality, Medicare’s coverage is limited — placing Medicaid, private pay, and planning at the center of the need. KFF
These numbers indicate a huge demand for Medicaid planning — and a wide gap between that demand and the number of firms offering that service (especially in more sophisticated, compliant ways).
The revenue potential: unit economics and lifetime value
To make the business case clear, let’s break down typical revenue per Medicaid planning client and how recurring fees emerge.
Upfront / project fees
Depending on complexity, Medicaid planning engagements can command fees ranging from $3,000 to $15,000+, especially in cases involving:
- Married couples with multiple asset classes
- Trust structuring (iPug®, irrevocable trusts)
- Medicaid-compliant annuities, promissory notes, QITs (Qualified Income Trusts)
- Look-back period “repairing” or restructuring older gifts or transfers
(Elder law / Medicaid planning sources often cite those ranges) medicaidplanningassistance.org
So if your firm closes 10 Medicaid planning cases per year at an average of $6,000, that’s $60,000 of new revenue from that service line alone.
Recurring / maintenance revenue
Beyond the project itself, there’s ongoing value:
- Annual Medicaid recertification and eligibility reviews
- Trust / asset management and updates over time
- Updates due to law changes, regulatory shifts, and state-specific rule revisions
- Additional related planning (e.g., estate, incapacity, elder care litigation)
Thus, a single client might produce fees year after year — not just a one-time engagement. That shifts your business from one-off transactions to lifetime client relationships.
Scaling effects & margin improvement
Because Medicaid planning relies heavily on systems and processes (calculations, document generation, workflows), the marginal time per additional case drops over time. As the team becomes proficient and uses integrated tools (like STEPS™), your effective hourly rate rises.
Firms that build a pipeline of Medicaid cases often see their profit margins jump 15–25% (versus pure estate planning) because there is less “new legal research” and more trust in repeatable workflows.
Operational advantages: integration, automation, control
Adding Medicaid planning doesn’t have to mean chaos. The firms that succeed do so by embedding it into their systems and technology stack.
1. CRM & client journey integration
- Track each client’s timeline (e.g. projection of when they’ll cross state eligibility thresholds, trust funding deadlines, look-back windows)
- Automate reminders for reviews, follow-ups, or documentation updates
- Monitor where each client is in the Medicaid plan / trust funding lifecycle
This turns Medicaid planning from a “siloed project” into part of a unified client lifecycle.
2. Automated calculation engine
Using software like STEPS™ (or equivalent), you eliminate reliance on manual spreadsheets or ad hoc calculators. Your attorney or staff simply input client data, and the system generates:
- Eligibility projections
- Penalty period / look-back assessments
- Asset protection scenarios
- Document drafts ready for review
This reduces error, speeds up delivery, and ensures consistency.
3. Document automation and templates
Trust documents, promissory notes, caregiver agreements, QITs, and ancillary documents are generated automatically, with state-specific logic layered in. That means less drafting, fewer custom one-off adjustments, and faster turnarounds.
4. Training, protocols & playbooks
Firms that scale Medicaid planning build standard operating procedures: checklists for intake, risk review, quality control, client education materials, and internal staff workflows. This consistency reduces bottlenecks and ensures smooth handoffs.
Risk mitigation & ethical compliance
Adding Medicaid planning brings regulatory and ethical responsibilities, but good systems mitigate many of those risks:
- Built-in compliance checks (look-back analysis, disallowed transfers)
- Audit trails and versioning of calculations and documents
- Legal updates and rule changes pushed via the software so you never rely on stale rules
- Client consent protocols and disclosures baked into templates
- Staff training on jurisdictional differences
Firms that do Medicaid planning well treat compliance as a selling point: “We use tools that safeguard against audit risk and adhere to each state’s statute.”
A pragmatic rollout strategy
Here’s a suggested phased roadmap to adding Medicaid planning:
| Phase | Focus | Key Actions |
|---|---|---|
| Pilot / Proof-of-Concept | Select a handful of trusted clients or pro bono cases | Use STEPS ™ internally, test workflows & document generation |
| Core Offering | Market the service to existing clients | Bundle Medicaid planning as an add-on or “upgrade” in your estate plan packages |
| Scale & Train | Bring staff or junior attorneys into the process | Establish SOPs, automation, delegation, QC checkpoints |
| Referral Network | Build referral sources | Align with CPAs, geriatric care managers, financial planners |
| Metrics & Feedback Loop | Monitor KPIs | Track # of leads, close rates, average fee, recurring revenue, client satisfaction, error rates |
Turning Client Need into Firm Growth
As long-term care costs continue to rise, clients are desperate for guidance, and they’re willing to pay for trusted legal expertise that protects what they’ve built. For estate planning firms, that creates both an obligation and an opportunity.
Medicaid planning isn’t just about helping clients qualify for care, it’s about positioning your firm as the go-to advisor for life’s most financially critical transitions. By integrating proven tools like LWP’s STEPS™ software and automated trust drafting systems into your workflow, you eliminate the guesswork, save time, and generate a measurable lift in both efficiency and profitability.
Every Medicaid case you handle builds recurring revenue through annual reviews, refilings, and trust maintenance, while deepening your client relationships and referral base. And with the aging population accelerating, firms that establish a systematized Medicaid offering today will be those best positioned for sustainable, predictable growth tomorrow.
The choice is simple: keep competing in a crowded estate planning market—or stand apart as the firm that helps families protect assets, qualify for care, and plan with confidence.
👉 Explore how Lawyers With Purpose can help you integrate Medicaid planning, automation, and business growth strategies into your practice. Schedule a discovery call today or email info@lawyerswithpurpose.com to learn more.
