How Does Nursing Home Medicaid Work?

Nursing HomeMedicaid is a government-funded program that takes many forms. Many New York residents are surprised to find out how many options they have for Medicaid coverage, including Nursing Home Medicaid.

Nursing Home Medicaid is one of the more comprehensive Medicaid programs, and it comes equipped with all Medicaid services from Community Medicaid and Community Medicaid with Long-Term Care. Also, you receive nursing home coverage as well as home care, adult day care, and assisted living care coverage.

Nursing home care in New York is costly – averaging more than $100,000 per year. Very few people have adequate resources, income, or even insurance to pay the costs of nursing homes. However, they need those long-term care services. Medicaid is the most common source for funding nursing homes and long-term care needs, but you need to apply for the proper coverage first.

How to Pay for Nursing Homes with Medicaid in Plainview, NY

A nursing home is a residential facility where you receive 24-hour nursing care and supportive services. Anyone who is 65 years or older, disabled, or legally blind qualifies for Medicaid, which handles nursing home fees. But you are only eligible based on income, resources, and if you require skilled nursing care.

Nursing Home Medicaid has stringent requirements. And unlike Community Medicare, Nursing Home Medicare does have a lookback period. Therefore, it is vital that you understand what these requirements are, and speak with an attorney to begin Medicaid planning sooner than later.

How to Qualify for Nursing Home Medicaid in New York

When you apply for Nursing Home Medicaid in New York, you are subject to substantial scrutiny. There are two primary areas that the state reviews when considering your eligibility: income and resources. Like other forms of Medicaid, you have strict monthly limits and maximum asset value amounts.

Your income is any money you receive per month or on a time-based schedule such as Social Security distributions, checks from a pension, or payouts from a retirement account. Your resources are assets. These assets include everything from investment accounts, stocks, bonds, savings accounts, or retirement accounts that you are not receiving a distribution from yet.

New York gives you a $50 per month income allowance if you are a nursing home resident. You cannot shelter income in a pooled income trust for Nursing Home Medicaid either.

Resource Limits for Nursing Home Medicaid

If you apply for Medicaid, you are subject to a nursing home resource maximum of $14,850. Any resources above this maximum must be spent down before you will qualify. If you exceed the resource value, speak with an elder law attorney to see how you can salvage your hard-earned assets while still qualifying for Medicaid.

The Five Year Lookback

Community Medicaid has no look-back period, but Nursing Home Medicaid does. If you want to gift or transfer assets to qualify for Medicaid without the hassles of spending down, you are subject to a look-back period of five years. Therefore, after you have completed all transfers, you must wait five years to apply or pay the penalty if the transfer was within the five year look-back.

The penalty rate is based on regional rates. For example, in 2017 the regional rate per month was $12,157 for New York City. Therefore, if you transferred assets, the value of those assets in the five year period would be divided by the regional rate to determine your penalty.

New York bases regional rates by the district. For example, New York City has a different rate than Northeastern New York (i.e., Albany, Greene, Hamilton, or Washington). You can see a full list of Medicaid Regional Rates online.

During your penalty months, you will not receive Medicaid payment. Instead, you pay privately for nursing home care until the penalty period is up. Then, Medicaid will take over payments.

For example, you transferred $100,000 in assets within the five year look-back. You live in Manhattan; therefore, as of 2017, the regional rate is $12,157. You would be subject to a penalty of 8.22 months for the transfer. If you lived in the Central New York District, the regional rate is $9,511, which means your penalty would be 10.5 months.

Intent to Return Home

Your home’s equity is exempt from resource considerations if you can prove that you intend to return home. Intent is subjective, but if there is a possibility that you will leave the nursing home and return home, you can request an exemption. The state could place a lien on your property if you are not reasonably expected to return home. Therefore, you must be cautious about claiming this exemption.

Other Exempt Income and Resources

You can also spend down your excess income to qualify for Nursing Home Medicaid. For example, if you are spending money on health insurance premiums, that money is not counted when the state reviews your income. Also, if you receive payments from specific resources, the state may allow for exemptions such as Holocaust restitution payments.

Contributing Your Income

If you are considering staying in a nursing home, the Nursing Home Medicaid program does require that you contribute your monthly income to the cost of your care. You are only allowed to retain $50 per month for yourself. You can pay your excess income to the Department of Social Services to keep eligibility, but it may be in your best interest to find a more useful way to spend the excess and reduce resources.

Speak with an Elder Law Attorney

Limiting your income and resources for Medicaid planning is a highly complicated process. The sooner you start it, the better the outcome might be and the less likely you are to face long-term Medicaid penalties.

If you plan to or suspect that you will need nursing home care at some point later in life, start the process of Medicaid planning now. Contact the Law Office of Andrew M. Lamkin, P.C. Attorney Lamkin can help you cover your bases when it comes to reducing resource value, limiting income, and qualifying for Medicaid.

Explore your options for long-term care planning by scheduling a free consultation at 516-605-0625 or request more information about elder care services online.

What Is Community Medicaid and Who Qualifies for It?

Nurse caring for an elderlyNew York offers various homecare and nursing home care solutions for aging residents. To determine which type of services you qualify for, you need to assess your budget. Depending on your income, age group, and disability status, you may be eligible for individual types of Medicaid coverage offered by the state.

Community Medicaid is one of those options. You may qualify for Community Medicaid or Community Medicaid with Long-Term Care if you are over the age of 65, blind, or certified disabled by the Social Security Administration or NY State.

What Does Community Medicaid Cover in Plainview, NY?

Community Medicaid is a health insurance program that handles most healthcare-related expenses such as doctor’s office visits, hospitalization, laboratory testing, and prescription medication.

If you are disabled, aged, or blind, you most likely have Medicare coverage and Medicare is your primary health insurance. However, Medicaid is a health insurance supplement. Community Medicaid helps bridge the gap between what Medicare covers and what you would otherwise pay for out-of-pocket. If you already have a supplement policy, such as Medigap, then Community Medicaid would cover anything after both policies are exhausted.

Another key coverage you receive with Community Medicaid is prescription drugs. Medicare does not cover prescriptions directly. Instead, Medicaid pays to Medicare under free Medicare Part D to cover your prescription drug costs.

What Is Community Medicaid with Long-Term Care

Community Medicaid with Long-Term Care works like Community Medicaid regarding prescription and health insurance coverage. However, it also offers additional coverage for long-term care services such as adult day care, assisted living, or in-home nursing care.

Do You Qualify for Community Medicaid?

Medicaid eligibility is based on income and resource limits. Therefore, you must pass a means-tested system. If you have low income and limited resources, then you may qualify for Community Medicaid.

The means-based system considers two financial categories:

  • Income – This is any money that you receive on a scheduled basis including pension payments, IRA distributions, and Social Security payments.
  • Resources – Resources involve your assets that could be used to pay for health expenses and in-home nursing care. These are assets such as your savings accounts, stocks and bonds, real estate, and an IRA that you are not currently receiving a distribution from.

Income and Resource Limitations for Community Medicaid to Know

Medicaid has income limits, which include:

  • $825 per month for an individual
  • $1,290 per month for a couple

Anyone that is aged, disabled, or blind qualifies for a $20 per month disregard. Therefore, if you are in one of those categories, you would have an income limit of $845 per month as an individual, and $1,310 per month for couples. Couples only receive a one person $20 disregard.

The resource limits are in addition to income limits, and they include:

  • $14,850 per individual
  • $21,750 per couple

If you are not looking for long-term care coverage, you can declare your assets and you are not required to document them for the application. If you do want long-term care coverage, you must record your resources. Resources are the primary determination of whether you qualify for Community Medicaid or Community Medicaid with Long-Term Care. Therefore, if you do not need long-term care, you will not have a heavy emphasis on your resources.

What If You Exceed the Limits?

Even if you exceed these limits, you could still qualify for Community Medicaid programs. There are  ways to help you qualify even when your income or resources go over the threshold. However, you should consult with a Medicaid planning attorney to explore these options. An attorney can review your expected income and current resource value, then help with a Medicaid or Medicare plan that legally assists you with qualifying for these forms of assistance.

Most options involve doing a spend down. This means that you spend to a specific threshold to help qualify for Medicare.

These are some options when you exceed the limits.

  • Paying Medical Bills – If you have monthly medical expenses that are more or equal to the amount of income over the threshold, Medicaid will ignore the excess income and allow you to qualify for Community Medicaid benefits.
  • Income Trust – New York is a state that realizes that $845 per month is not enough to cover someone’s cost of living let alone medical care. That is why they allow residents with excess income to establish a Pooled Income Trust. With an attorney’s help, you can set up the trust and then deposit the surplus income into the trust. Then, you submit your living expenses to the trust for reimbursement and the trust pays your bills. A Pooled Income Trust must meet specific state requirements, and you must provide monthly contribution records to show that it is active.
  • Paying Medicare Provider – If you do not want to use a Pooled Income Trust, you can spend down your excess income by paying your Home Care Medicaid Provider directly and contributing to the cost of care.

Earned Income

Some individuals that exceed the income amount may be able to claim for earned income.

For example, an applicant works part-time and earns $1,065 per month. All earned income qualifies for a $65 disregard, and the remaining income is divided by two. For Medicaid budgeting, that applicant can deduct $65 from earned income totals, leaving them with $1,000 per month. Once that amount is divided by two, they have a budgeted earned income of just $500 – qualifying them for Medicaid.

Considering the Look-Back Period

When your resources and income disqualify you from Medicaid, you may want to spend down so that you qualify. Spending down might include transferring assets to other family members so that you have fewer resources holding you back.

When applying for Community Medicaid, you can do this. Community Medicaid does not have the look-back period that other Medicaid programs do, which gives you more options for spending down before applying.

Need Assistance with Medicaid Planning?

If you need help with Medicaid or Medicare planning, speak with attorney Andrew M. Lamkin at the Law Office of Andrew M. Lamkin, P.C. Spending down resources and moving assets is complicated, and you want to ensure you follow the proper procedures so that you do not disqualify yourself from much-needed Medicaid coverage.

Schedule a free case evaluation at 516-605-0625 or request more information online.

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