MEDICAID PLANNING CLIENT QUESTIONNAIRE Preview on Page 1

MEDICAID PLANNING CLIENT QUESTIONNAIRE 2026

The document is a Medicaid Planning Client Questionnaire from Hawkins Law PC, designed to collect comprehensive information about clients needing nursing home care. It includes sections for personal details, financial information, insurance coverage, and resources owned by the client and their spouse. Additionally, it provides a checklist of necessary documents for the Medicaid application process, emphasizing the importance of thorough documentation to facilitate the planning and application.

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Click ‘Get Form’ to open the MEDICAID PLANNING CLIENT QUESTIONNAIRE in the editor.
Begin by filling out the first section regarding how you heard about Hawkins Law PC. Select from options like Newspaper, Internet, or Family/Friends.
Proceed to provide detailed information about the person needing nursing home care (Client #1). Fill in their full name, marital status, and address. If applicable, include details about a deceased spouse.
Continue with Client #1’s medical and legal information. Indicate if they have a Last Will and Testament, Trust Agreement, or Power of Attorney. Provide their general medical diagnosis and education level.
If there is a current spouse (Client #2), complete their information similarly. Include contact details and any relevant legal documents they may possess.
Fill out sections regarding children or other involved persons, nursing home information, Medicare and health insurance details, income information, resources owned, liabilities, transfers made in the last five years, and any additional notes for discussion.

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