| Read Time: 4 minutes | Medicaid

You might not need community-based care, and you may not even be close to retirement, but regardless of where you are in your life, now is the ideal time to start planning for Medicaid. For the past two months, we have gone over the significant changes to Medicaid’s lookback period – specifically involving those who need community-based care.

Today, we are going to go over the pre-planning process, which means not only considering the new budget changes but the rules that stayed the same for 2020 and beyond.

Basic Eligibility – What Are the Biggest Factors That Determine Eligibility?

Before you get into the details, there are factors that must apply for you to even think about seeking out Medicaid coverage, and those factors are:

  1. Are you an adult over the age of 64? You must be an elderly adult that is over the age of 64 to apply for Medicaid benefits in New York.
  2. Are you disabled and unable to work or care for yourself? If you are younger than 64, then you must have a qualifying disability that prevents you from earning a living.
  3. You are currently pregnant or have a child that is under the age of 18? You must be an expectant mother in need of insurance or have a child that is under the legal age of 18.
  4. Are you or a child, spouse, or parent legally blind? You may not be disabled, but the state sees blindness as a qualifying factor for Medicaid. Whether it is yourself or a spouse, child, or parent you care for, the party that is blind may qualify for Medicaid coverage.

New York will review your income and see if you fall into one of the two qualifying categories. However, income is not the only factor here. Even if you fell below the poverty level, you are not automatically qualified for Medicaid coverage.

Supplying Financial Statements to Prove Income and Assets

As stated before, the four factors above are a starting point. From there, you must also have an income that falls below the state’s poverty level – and this income limit is quite low.

The state has an online tool that helps you look up the most recent income requirements based on your household size. At the time of this post, a single person can only have a maximum of $16,971 income per year, while a household of two can have a maximum of $22,930. For a family of five, the maximum household income each year can only be $40,805. These are all gross income figures (meaning the amount you make before paying taxes), which may make it even harder to qualify.

If your income is below the maximum annual allowed, and you also fall under one of the four categories, then you can apply for Medicaid coverage. However, part of the application is submitting financial statements, and there is a lookback period that goes back several years, depending on the type of Medicaid coverage you are looking for.

Typically, the state will require 60 months’ worth of financial records, which is five years. While not all types of Medicaid coverage look back five years, they will want those statements just to speed up the processing of your application. Medicaid services review these statements to decide if your income is lower than the maximum and to see if you have any assets that you could use to pay for your medical or community-based care.

What Happens If You Have Assets?

Assets are often what impacts people. They might have a low income, and they could qualify for Medicaid, but they have an asset that the state will see as usable toward their community-based care first. Also, if you were to transfer that asset to someone else during the lookback window, then you are subject to a penalty.

5 Years Is a Long Time – Now Is the Time to Take Care of Your Assets

If the state looks back five years to see how much you have earned or what assets you have acquired, then it is unlikely you would qualify for coverage. That is why you should start planning now rather than waiting until you need coverage.

How an Estate Planning Attorney Prepares You for Medicaid

An estate planning attorney can help you prepare for Medicaid – whether you need it now or 10 years down the road.

These professionals specialize in the New York laws surrounding Medicaid applications. Whether you have already been denied coverage or you just want to start the planning process, a Medicaid attorney is critical – especially with so many new changes to the law after COVID-19 impacted state budgets.

Just some of the ways a Medicaid attorney can help include:

  1. Reviewing current assets and looking for spend-down opportunities. Your assets play a key role in approval. Therefore, an attorney will need to review your existing assets and determine which could affect your application. Your attorney might also create a spend-down plan, which has you spend down assets and ensure you qualify when the time comes.
  2. Reviewing your denial and appealing if need be. You might have already applied, but you were denied benefits. An attorney can review the denial letter and help file your appeal. Sometimes, it is as simple as incorrect paperwork or checking the wrong box, while other times it is more complex.

Bottom Line: You Need the Help of a Professional

No matter when you plan to apply, if you are considering community-based care or you have another need for Medicaid coverage, now is the time to act. The sooner you begin preparations, the more likely you are to succeed when you file your claim.

The Law Office of Andrew M. Lamkin, P.C., has helped countless families just like yours qualify, appeal, and successfully receive the Medicaid benefits they are entitled to. The best thing you can do right now is to contact our office for a no-obligation case evaluation. If you prefer to do so from the comfort of your home, we offer teleconference consultations, too.

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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