2016 Medicaid Income Limit For Home
Single Person receiving home care: $825
Couple both receiving home care: $1,209 (+$20 exemption)
*Individuals who exceed these limits may be eligible under the Surplus Income Program (giving it to Medicaid).
Surplus income (over $825) is contributed to the cost of care, unless a 'Pooled Income Trust" is established. A
"Pooled Income Trust" can shelter income so that it may be used for expenses not covered by the Medicaid
**NEW Married person option - if married and only
one is applying for Medicaid home care - couple may be permitted to keep up to $3,312 of their combined income each
month (this will require an analysis of the couples monthly income).
Medicaid Income Limit For Nursing Home
$50 per month.
All surplus income must be given to the nursing home, unless there is a well spouse living in the community who may be allowed
to retain a portion of their institutionalized spouses income.
Medicaid Resource Limit For Home Care
Single Person: $14,850
Couple, both on Medicaid home care: $21,750
Limit for well spouse - well non-applicant spouse may be permitted to keep $74,820 (protected from Medicaid claim)
- this will require an analysis of the couples total assets.
- Pre-paid funeral (no limit on value) is exempt: must be in a special contract
with the funeral home;
- Car and Personal Effects are exempt;
remains exempt as long as the applicant or their spouse contine to reside in the home (max. home value of $828,000
) *(must be your primary residence).
*While exempt for eligibility purposes,
a home may be subject to claims or liens by Medicaid, unless proper planning is put in place prior to the death of the Medicaid
** Note: Placing your home in a "Living Revocable Trusts" will not
prevent Medicaid from placing a lien on the home should a person need to receive nursing home Medicaid coverage.
- Retirement Accounts (IRA-401K) of the applicant and the applicant's spouse. The applicant's retirement accounts
must all be paying out the maximum allowable distribution based upon life expectancy. (note: income from these
accounts is not exempt and will be considered countable income)
Certain income is not counted for eligibility purposes.
- Restitution payments from Nazi persecution
- Income diverted into an approved "Pooled
Income Trust" (home care only)
Transfer Penalties for gifting your
assets apply to nursing home care only
There are only transfer penalties imposed for nursing home coverage, there are no
penalties for community home care services. Therefore, you may transfer your assets this month and become Medicaid eligible
the next month.
2016 Spousal Allowances
The non-applicant spouse is permitted to retain the following amounts when their spouse enters a nursing home with
Well spouse Income : $2,980.50 per month from their combined
income -- if this amount is exceeded, then Medicaid may request monthly income contributions from the well spouse;
Well Spouse Resources: Between $74,820 and $119,220 (approximate - maximum) --
if this amount is exceeded, then Medicaid may seek reimbursement from the well spouse holding the money.
Medicaid Estate Recovery Rights
Medicaid always retains the
right to seek repayment for all services rendered to a Medicaid applicant from their probate estate; they may also seek reimbursement
from a legally responsible relative (spouse). Therefore, it is important to try not to leave any assets in the applicant's
name that might go through probate upon their passing.
Coverage Under Medicaid
Once on Medicaid, all pharmacy coverage will be handled
by "Medicare Part D". Medicare Part D is a prescription drug benefit available to everyone with Medicare.
It has special importance to people with Medicare and New York State Medicaid because Medicare Part D replaces
Medicaid in paying for most of your prescription drugs.
Under the Medicare Part D prescription
benefit almost all of your drugs costs will be paid for by Medicare instead of Medicaid. You will
get prescription drug coverage from Medicare and pay a small Medicare copayment for each prescription. If
you currently receive NYS Medicaid and you do not join a Medicare prescription drug plan, you may lose all your NYS Medicaid
When you become eligible for both Medicare and Medicaid you will automatically be assigned
to a Medicare Prescription Drug Plan to make sure you don't miss a day of coverage. You can also enroll in a plan of your
own choosing that may better meet your prescription drug needs. Information about available plans and the “Medicare
& You” handbook is available from Medicare. Be sure to read this information to understand all the changes.
For more information, click on or call:
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