04/26/2018










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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