October 21, 2014










Community Medicaid in New York State

How to Stay at home and protect your assets and income

In New York, the Community Based Medicaid program will pay for the cost of a home health aide. When applying, the local department of social services considered the applicant’s income and assets and whether the Medicaid applicant requires the assistance with the activities of daily living. The following is a breakdown of how DSS evaluates each for a New York Community Medicaid application.

Activities of Daily Living

An individual over the age of 65 is considered “disabled” and therefore entitled to Community Medicaid benefits if they need assistance with the activities of daily living, These include bathing, dressing, toileting and feeding. For most that are interested in Community Medicaid, this is not a difficult a difficult threshold to reach. Any applicant with the onset of dementia or Alzheimer’s or with physical disabilities that limit their ability to live on their own, is sufficiently “disabled” enough to receive Community Medicaid benefits.

Income

Income is calculated by adding the following: Social Security, Pensions, income from rental properties or other investments, and require minimum distributions from retirement accounts. Under Community Medicaid rules in New York, the Medicaid recipient is entitled to keep $787 per month of their income. The remainder of the recipients income is called a “spenddown”. The Medicaid recipient is required spend the remainder on the cost of the aide. Medicaid will pay the difference.

Most of those who can stay at home will have expenses far exceeding the $787 limit. Medicaid understands this and allows for an exception. The often used exception is called a “Pooled Income Trust”.

Clearly, for many recipients of Community Based Medicaid, loss of income would prevent them from remaining in their homes. Enter the Pooled Income Trust. A Pooled Income Trust is similar to a bank account, however it administered by a Non-profit Trust Company, such as NYSARC Trust Services or AHRC.

If Mr. Smith has a monthly income of $2,787 in Social Security and pension income, and he is receiving Medicaid benefits for home care in her Long Island home, he has $2,000 in “excess income” under the current Medicaid rules. As a result, Mr. Smith is required to send a check each month in the amount of $2,000 to his home care agency as a contribution to the cost of his care.

However, when Mr. Smith joins a qualified pooled income trust, his $2,000 check will be sent to the trust instead of his home care agency. The trust will then be able to pay any of Mr. Smith’s expenses, such as his utilities, his food, or his clothing, from his own funds or even the taxes on his Long Island home. Mr. Smith will continue to receive his Medicaid home care, as well.

The pooled income trust contains the funds of many disabled persons and is managed by a non-profit organization that maintains separate accounts for each individual. In order to participate in the trust, the disabled person (or his representative acting under durable power of attorney) signs an agreement with the trust. Under this agreement, upon the beneficiary’s death, if there are any remaining funds they are kept by the trust.

Those who wish to participate in a pooled income trust will have to establish that they are disabled, but findings of disability by the Social Security Administration or by Medicaid are valid for this purpose.

Assets

For Medicaid purposes in New York, assets include any real property owned by the applicant or savings in the form of money markets, CD’s, stocks, bonds, cash values in insurance policies, and other non-retirement investments. When applying for Community Medicaid in New York, the applicant’s total assets must be under $13,800. Clearly, most individuals in New York City, Queens, Brooklyn, and Long Island, are worth more than $13,800.

Many have heard of a five-year look-back period on asset transfers when applying for Medicaid. It is true that a five-year look back period exists – but only for Institutional Medicaid application where the applicant is residing in a nursing home. When applying for Community Based Medicaid applications in New York, there is no five-year look back. Therefore, an applicant can transfer their assets in month and apply for benefits the following month. The best way to transfer assets can only be determined on a case by case scenario. While in some cases it may be appropriate to transfer assets to other family members, including adult children, in other cases it would more advisable to transfer the assets to an Irrevocable Trust.

Most people are not aware of the eligibility requirements for Community Based Medicaid in New York. This is unfortunate because many individuals who could be eligible are spending down their savings on the cost of a home health aide. Whether an individual requires an aide for the first time (perhaps they are leaving a rehab facility) or have had an aide with them and are paying privately, many can eligible for Community Medicaid benefits with the proper planning.

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Pooled Income Trusts

How to protect your excess income when receiving community Medicaid

A Pooled Income Trust is an option for a disabled individual who has excess income while receiving Community Medicaid Benefits.

Here is how it works:

Recipients of Community Medicaid – those who receive the assistance of a home health aide – are allowed to keep $787 per month of their income. Any additional income, called a “Spendown”, is supposed to be spent down on the individuals care. Therefore, if a Medicaid recipient has income of $1,500 per month, they would be allowed to keep $787 and the remainder would go to the home health aide – with Medicaid paying for any additional costs of the care.

However, for many recipients of Community Based Medicaid, loss of income would prevent them from remaining in their homes. Enter the Pooled Income Trust. A Pooled Income Trust is similar to a bank account, however it administered by a Non-profit Trust Company, such as NYSARC Trust Services or AHRC.

If Mr. Smith has a monthly income of $2,787 in Social Security and pension income, and he is receiving Medicaid benefits for home care in his Long Island home, he has $2,000 in “excess income” under the current Medicaid rules. As a result, Mr. Smith is required to send a check each month in the amount of $2,000 to his home care agency as a contribution to the cost of his care.

However, when Mr. Smith joins a qualified pooled income trust, his $2,000 check will be sent to the trust instead of his home care agency. The trust will then be able to pay any of Mr. Smith’s expenses, such as his utilities, his food, or his clothing, from his own funds or even the taxes on his Long Island home. Mr. Smith will continue to receive his Medicaid home care, as well.

The pooled income trust contains the funds of many disabled persons and is managed by a non-profit organization that maintains separate accounts for each individual. In order to participate in the trust, the disabled person (or his representative acting under durable power of attorney) signs an agreement with the trust. Under this agreement, upon the beneficiary’s death, if there are any remaining funds they are kept by the trust.

Those who wish to participate in a pooled income trust will have to establish that they are disabled, but findings of disability by the Social Security Administration or by Medicaid are valid for this purpose.

Deficit Reduction Act of 2005 – Impact on Medicaid

By Andrew M. Lamkin, Esq.

On February 8, 2006, President Bush signed into law the Deficit Reduction Act of 2005 (DRA). The Act reduces federal entitlement spending for Medicaid, among other federal programs. The Medicaid program pays for services for disabled seniors who meet the eligibility requirements. Most commonly, Medicaid pays for the cost of home health aides and nursing home care.

The effects of the Deficit Reduction Act on Medicaid are significant, especially when applying for nursing home benefits. First, the look back period on asset transfers has been increased from three to five years. When an uncompensated transfer, or gift, is made during this look back period, Medicaid will impose a “penalty period.” The “penalty period” is the length of time during which Medicaid will not pay for the cost of nursing care, during which time the family of the applicant is responsible. At the end of the penalty period, Medicaid will pick up the cost of care. Due to this change in the law, the goal when establishing an estate plan is to protect assets five years before having to apply for Medicaid. Unfortunately, it is difficult to anticipate when a family member may be forced to enter a nursing home. To ensure you are eligible for Medicaid should the need arise; it is advisable to plan well ahead of time.

The second major change as a result of the DRA, is in regard to the start of the penalty period. Under the old law, the penalty period began on the date when the assets were transferred. Depending on the fair market value of the transfer, the penalty period may have expired by the time the application was filed. Therefore, an applicant who transferred assets within the three year look back may have qualified for Medicaid before the time they apply.

Under DRA, however, the penalty period begins when the applicant applies for nursing home benefits. Therefore, any transfer made within the 5 year look-back period will certainly result in a penalty period. This is a drastic change and many applicants will be ineligible for a longer period of time. This will require applicants to pay for the cost of the nursing home with their savings, and perhaps require the sale of the family home.

A common misconception is that if proper planning has not occurred by the time a person enters a nursing home; there is no option other than to exhaust his savings. In reality, this is not the case. The opportunity to protect all of the assets may be lost, but by utilizing a strategy known as “Reverse Rule of Halves,” it is possible to protect up to one-half of the applicant’s assets. In order for this strategy to work, it is vital to transfer assets as soon as the person enters the nursing home.

It is also important to note that there are a few exceptions to transfers made during the look-back period. Transfers made within the look back period to a spouse or disabled child do not result in a penalty period. Furthermore, an applicant can transfer his home to a “caretaker” child. This exception applies only in a situation where a child of the applicant has been residing with the applicant in the applicant’s home for at least two years. In this situation, the applicant can transfer the home to the “caretaker” child while, retaining a life estate.

Fortunately, the eligibility requirements for Community-based Medicaid, where a home health aide is provided, are more lenient than nursing home based applications. Most importantly, there is not a look-back period on assets transfers. Hence, an applicant for Community Medicaid may transfer assets for the purposes of qualifying without the imposition of a penalty period. Therefore, an applicant can transfer assets to anyone in March and be eligible for Community Medicaid in April.

A big concern with community based applications is the “spenddown” requirement imposed on income over $767.00 per month. Any income over this amount must be “spent down” on the cost of care and Medicaid will pay for the remaining cost. For example, if an applicant receives Social Security benefits and a pension totaling $2,500 per month, he is allowed to keep only $767.00 per month. He is required to contribute the difference of $1,733 per month to the cost of the home care aide. If the aide costs more than $1,733 per month, Medicaid will pick up the difference. However, with proper planning and the use of a Pooled Income Trust, it is possible to protect 100% of the applicant’s income and he will not have to contribute to the cost of the home care aide. Therefore, by utilizing a Pooled Income Trust, Medicaid will pay for the entire cost of the home care aide.

Overall, the Deficit Reduction Act makes it more difficult for those in need to qualify for Medicaid benefits. The new provisions are complex and can be difficult to navigate. With these changes, it is even more important for the protection of your family to have a plan in place.

Taking time to speak with an Elder Law attorney can help to devise a plan that will insure that your loved ones receive the necessary care they need, while at the same time protecting their income and assets for their use.

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