07/23/2018










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.



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