| Read Time: 4 minutes | Medicaid

Medicaid is the single largest source of health coverage in the United States. About 80 million Americans are currently enrolled in Medicaid. If you are considering applying for Medicaid, you may be wondering, Can I pass the income assessment of a New York Medicaid? In this blog, we discuss the requirements for the income assessment for Medicaid in New York.

Why You Might Need Medicaid

Medicaid is available for those with qualifying medical or financial needs. Although you might have health insurance, Medicaid is a joint federal and state program that can provide additional coverage for healthcare costs. Medicaid is particularly helpful for those who need long-term services, such as 24/7 in-home skilled nursing care. New York’s Medicaid can even pay for non-medical services, such as personal care assistance, necessary to support seniors living in their homes.

Who Is Eligible for Medicaid in New York?

There are several different eligibility categories for Medicaid in New York, including pregnant women, children, and disabled persons. In this blog, we focus specifically on Medicaid eligibility for New Yorkers aged 65 and over. This category of applicants must meet the income and resource test to receive Medicaid benefits.

Types of Medicaid Programs

There are three types of Medicaid for seniors who need long-term care services.

Nursing Home or Institutional Medicaid

This program is for care provided only in nursing homes, and anyone who is eligible will receive assistance.

Medicaid Waivers—Home and Community-Based Services (HCBS)

This type of Medicaid is aimed at delaying nursing home admissions, so services like at-home care, adult daycare, and assisted living facilities are covered. Only a limited number of individuals will receive this type of Medicaid, as it’s a non-entitlement program.

Regular Medicaid

This is a broad Medicaid program that’s available to anyone who is eligible. Regular Medicaid covers different long-term care services, including personal care assistance.

What Are the Requirements for the Income Assessment for New York Medicaid?

There’s a certain income limit you cannot surpass if you want to pass the income assessment and qualify for New York Medicaid. The income limit varies based on your marital status and the type of Medicaid you’re applying for. Before diving into the numbers, let’s first take a look at the definition of income for Medicaid purposes and the different types of Medicaid programs. 

What Qualifies as “Income”?

All income from any source is counted toward the income limit. This includes the following:

  • Employment wages;
  • Pension payments;
  • Alimony payments;
  • Annuity payments;
  • Social Security Income (SSI);
  • Social Security Disability Income (SSDI);
  • Cash gifts; and
  • Payments from Individual Retirement Accounts (IRAs).

There are some additional nuances when it comes to what is and is not considered income, so it’s best to speak with a Medicaid lawyer who can provide guidance. For example, Covid-19 stimulus checks are not considered income for Medicaid eligibility purposes.

Another intricacy of Medicaid qualifications is the income of the non-applicant spouse. Depending on the type of Medicaid you are applying for, your spouse’s income may or may not be considered.

Income Assessment Requirements

As mentioned above, the income limit requirements vary based on marital status and Medicaid type.

Single individual

The income limit for a single person applying for any of the three types of Medicaid is $934 per month.

Married individual (both spouses applying)

For married persons where both spouses are applying for Medicaid, the income limit is $1,367 per month. The amount is the same regardless of the type of Medicaid you are applying for.

Married individual (one spouse applying)

The income limits change when only one spouse is applying. For HCBS and Institutional Medicaid, the monthly income limit is $934. For regular Medicaid, the income limit is $1,367.

There is also a 30-month look-back period that gives the New York State Department of Health the authority to review an applicant’s financial statements. This can significantly impact your ability to qualify for Medicaid. 

Between completing the application and compiling the necessary documents, applying for Medicaid can be a tedious and time-consuming process. Contact the Law Office of Andrew M. Lamkin, P.C. for assistance.

What Happens If You Can’t Pass the Income Assessment?

Even if you are above the income limit, you may still be eligible for Medicaid.

Medicaid Spend Down Program

New York offers a Medicaid Excess Income Program (also called a Spenddown Program or Medically Needy Pathway) for those with high medical bills. A “spend down” is the amount of excess money you have over the income limit that you have to “spend down” to satisfy the income eligibility requirement and qualify for Medicaid each month. However, there are limitations on how you spend the excess money. For example, you cannot pay bills or go grocery shopping with the money.

There are three options for spending down the money:

  • Submit unpaid medical bills (equal to or greater than the excess amount) to the Department of Social Services (DSS) with prior approval;
  • Pay the excess income amount directly to the DSS or your Medicaid plan; or
  • Place the excess income into a Supplemental Needs Trust or Pooled Trust, but only if you’re disabled.

Talk with our highly-skilled Long Island Medicaid attorney, Andrew M. Lamkin, to discuss your options.

Medicaid Planning

A Medicaid planning professional, like lawyer Andrew M. Lamkin, can help you plan for long-term care costs. By implementing strategies and rearranging assets, he can help you qualify for Medicaid.

How Can a Long Island Attorney Help?

Qualifying for Medicaid is a long, complex process. You want someone assisting you who knows the intricacies of the law and can best plan to protect your assets. Principal attorney Andrew M. Lamkin is a skilled, compassionate Medicaid lawyer with over 15 years of experience. He helps New York individuals with their Medicaid needs, including applying and Medicaid planning. To schedule a free consultation with Mr. Lamkin, call or go online to request an appointment. He’s happy to meet with you in his office or at your home. 

Author Photo

Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.

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