Medicaid is a means-tested government health insurance program providing eligible individuals with medical care, services, and prescription drug coverage. Medicaid benefits include a full range of health care services, home care and institutional care services, medications, and medical supplies, many of which are not provided by Medicare or other programs or insurance. Home care, long term nursing home care, physicians, dentists, inpatient services, outpatient services, physical therapy, occupational therapy, prescription drugs, dentistry, eyeglasses, hearing aids, medical supplies, and a myriad of services may be covered by Medicaid if the services are medically necessary and the recipient is eligible.
Individuals applying for Medicaid must prove that they meet certain requirements, including citizenship or legal United States resident status. Applicants must apply in the state and county where they reside, defined as physical presence and the intent to remain permanently or indefinitely. Medicaid eligiblity for disabled, aged, and blind individuals ["DAB Medicaid"] is based on the income and resources of the person and responsible family members (spouse, or parent of a minor child). In 2021, for an unmarried applicant, the New York State resource/asset limit is $15,900 and the income limit is $884.00 per month (plus a $20.00 per month disregard in New York City and some counties). Some resources are not counted in determining your eligibility for benefits, including your primary residence (subject to an equity cap of $906,000), one car, burial allowance of $1,500, burial space, prepaid irrevocable funeral account, personal belongings, furnishings, jewelry, and qualified retirement accounts and qualified annuities in payout status.
For married couples, the 2021 income level for home care (Community) Medicaid is $1,300 per month and $23,400 in resources. To prevent spousal impoverishment when a spouse enters a nursing home for long term care, in 2021 the community spouse can keep a higher level than the home care allowance: up to $130,380 in resources, plus $3,259.50 per month in income.
The Medicaid Spend-Down program is available for those who do not meet the income requirements for Medicaid and are aged, blind, or disabled, under 21, pregnant or ADC (Aid to Dependent Children) related. If your income exceeds the limits, you may qualify for the Medicaid home-health-care program if you incur or pay medical charges equal to your excess countable income or use a Pooled Income Trust for the excess (surplus) income. The Pooled Income Trust rules have recently changed, and the implentation of these changes is in a state of flux, but the Pooled Income Trust remains available for many as the best spend-down option notwithstandign the pending changes.
MAGI Medicaid is a program available under the Affordable Care Act for individuals under 65, children, pregnant women, and parents and caretaker relatives. MAGI Medicaid eligibility is based on an income limit of $1,467.40 per month in 2021 for an unmarried applicant who is not disabled, aged, or blind. Unlike DAB Medicaid, MAGI Medicaid does not have a resource/asset limit.
There are strict penalties imposed for traditional Medicaid for the transfer of assets if long-term nursing home (institutional) care is needed. Under the nursing home transfer of resources and income rules, the Medicaid office will look at uncompensated transfers or gifts made five years prior to the month of the application and will penalize the applicant as of the date of the nursing home application going forward based on their regional divisor and the amount of the transfers/gifts.
Until now, there has been no penalty period for the transfer of assets when applying for Community Medicaid (home-care services), some adult day-care programs, prescription drug coverage, medical care, and other Medicaid benefits and programs. However, originally scheduled to take effect October 1, 2020, and suspended until April 1, 2021, for the first time in New York, Community Medicaid applicants will soon be subject to a lookback period of 30 months with a resultant penalty period for benefits. The start date of this Look Back for Community Medicaid may be further suspended, pending possible further legislation given the Corona Virus Emergency and as the logistics and implementation by the Department of Social Services develop.
Other Medicaid changes scheduled to take effect on April 1, 2021 include increasing the threshold to qualify for personal care services, including CDPAP. New applicants will soon have to require assistance with more than two activities of daily living or be diagnosed with Dementia or Alzheimer’s Disease and require at least supervision or assistance with more than one activity of daily living. Housekeeping and other level 1 services will not be counted as care categories. An independent physician selected or approved by the New York State Department of Health, and not the applicant’s treating physician will soon be required to prescribe personal care services. Plans for the implementation by the Department of Social Services to encompass these changes is underway, and how this will affect our clients is of concern.
For an update on the Medicaid changes scheduled to take effect April 1, 2021, please click here.
It is crucial that you do not transfer any of your assets before consulting an elder law attorney who is well versed in the fields of long-term care, benefits and entitlements, preservation and transfer of assets, Medicaid, Medicare, and disability planning.
If Medicaid Home Care or Nursing Home services are on you or your loved one's horizon, you will be required to provide all financial statements (each and every page for each and statement for each and every account) throughout the lookback period(s). Be proactive, save all financial statements, and do your planning ahead of time.
In order to plan for your future or if you have any questions, please feel free to contact Fern J. Finkel or Julie Stoil Fernandez at Finkel & Fernandez, LLP, 16 Court Street, Suite 1007, Brooklyn, New York 11241, 347-296-8200 (telephone), 718-965-3185 (fax), , .
*Disclaimer: The information contained on this website is provided only as general information and is not intended as legal advice, nor should it be used as a substitute for a complete review of your case by an experienced elder law attorney. All situations differ. By visiting this website, there is no attorney-client relationship established between you and Fern J. Finkel, Julie Stoil Fernandez, or Finkel & Fernandez, LLP.