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By Nancy J. Brady, Esq., Partner, Brady & Marshak, LLP Attorneys at Law

If you are 65 or older, or have been receiving social security disability for at least two years, you are by now aware of what Medicare is- the red, white and blue card that provides insurance for doctor’s visits, some costs of hospitalization and very limited home care or a short stay in a rehab facility if certain qualifications are met.

If you have long term care insurance, those benefits may cover you for long term home care, or nursing home care. If you do not have long term care insurance, you may choose to pay for those services if you need them with your savings and income.

You should NEVER assume that because you have savings and income you would not be qualified for any other coverage for long term care through the NY State Medicaid program.

The type of Medicaid coverage discussed presently is a benefits program that finances long term care, either at home with home care services, or in a facility (Medicare pays for a maximum of 20 days in full, and 80 days in part, if someone meets medical qualifications).

The following is the list of qualifications one must meet to be considered for Medicaid coverage:

  1. Must be an elderly or blind or disabled New York resident.
  2. Must need assistance with activities of daily living.
  3. Must have below $14,850 in “countable” resources in the month you apply for coverage (some assets do not “count”, like IRA principal).
  4. If you transferred resources to be below $14,850 you will not be penalized or disqualified from applying for home care benefits.
  5. If you transferred resources (including real estate) to below $14,850 to be eligible for nursing home benefits WITHIN 5 YEARS of applying for Medicaid to finance the nursing home stay, you may be ineligible for Medicaid coverage for a period of time, depending on the value of the asset transferred, UNLESS the asset was transferred in accordance with the Medicaid regulations, which are quite limited.
  6. There are monthly income limits for Medicaid coverage. For full nursing home benefits all income except what the applicant pays for health insurance premiums, and $50, has to go to the nursing home each month (in addition to what the facility receives from the Medicaid program). This rule applies UNLESS the applicant is married. If so, the spouse at home is entitled to keep about $3000 from the combined total income. If the spouse earns more, then the spouse can do “spousal refusal” to keep more of the spouse’s income, but applicant’s income still has to go to nursing home.
  7. Income for home care applicants can be preserved in whole or in part to be spent on the Medicaid applicant’s bills, by establishing a Medicaid qualifying pooled income trust.Caveats:If no planning has been done in advance of a loved one needing NURSING HOME Medicaid benefits by working with an attorney, it is still possible to save / prevent spending at least half and possibly more of the assets on care by using well established planning that has been regulated by Medicaid. Planning ahead can result in protecting all assets if done properly and would avoid last minute crisis planning.If income is high, you will have to pay something to the nursing home. If, per month, your income is higher than the nursing home private pay rate you will not be eligible to apply for Medicaid. If you have high income and are eligible you may wish to consider long term care insurance as part of your overall plan.For the middle class, depending on one’s particular circumstances, Medicaid benefits can protect all, or a large portion of assets and income from having to be paid to the cost of care. Anyone approaching their 70s or older owes it to themselves and their loved ones to seek legal counsel to review what steps can be taken, and how life savings can be protected. Please do not hesitate to contact our office if you would like to discuss any of the information presented herein. Our office phone number is (718) 738-8500.

This is only a brief summary of the Medicaid regulations, and should not be construed as individual legal advice.