2025 Medicaid Income Limit For Home
Care (Community Medicaid) coverage:
This is a general explaination
- a complete explaination of how the Medicaid program works is provided at a full Medicaid planning consultation.
INCOME LIMIT: Single Person receiving
home care: $1,800 (+$20 exemption) -income over this amount should either be contributed
to the cost of monthly care (given to Medicaid) or it may be placed into a "pooled trust" each month.
Couple both receiving home care: $2,433 (+$20 exemption) - income over
this amount may be placed into a "pooled trust" each month or contributed to the cost of monthly care.
*Individuals who exceed these limits may be eligible under the Surplus Income Program (giving their surplus monthly
income it to Medicaid like a monthly co-pay). Surplus income (income over $1,800) must
be contributed to the cost of care, unless the surplus income is placed into a 'Pooled Income Trust". A "Pooled
Income Trust" can shelter income so that it may be used for expenses of the Medicaid recipient, that not covered
by the Medicaid program.
2025 Medicaid Income
Limit For Nursing Home Medicaid coverage:
$50
per month. All surplus income must be given to the nursing home each month, unless there is a well spouse living in
the community who may be allowed to retain a portion of their institutionalized spouses income.
RESOURCE LIMIT for any applicant, for all types of services: Single person is permitted
to retain a maximum of $32,396.00 in total countable available assets (checking,
savings, CD's.... and other non-exempt assets).
Transfer Penalty Rules
Currently
there are only transfer penalties imposed for nursing home coverage, there are
no transfer penalties for community
home care services . Therefore, you may transfer your assets this month and become eligible for community home care
services the following month. However, begining some time in 2026 there will be
a new waiting period imposed on home care applicants if they transfer funds prior to apply for home care services. *Implementation of the new look-back for home care services has been postponed unitl 2026.
2025 Spousal Allowances
The non-applicant spouse is permitted
to retain the following amounts when their spouse enters a nursing home with Medicaid coverage:
~Well
spouse Income : $3,948 per month from their combined income -- if this
amount is exceeded, then Medicaid may request monthly income contributions from the well non- applicant spouse;
~Well Spouse Resources: Between $74,820 and $157,920 --
if this amount is exceeded, then Medicaid may seek reimbursement from the well spouse holding the excess funds.
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 avoid leaving any assets in the applicant's
name that might go through probate upon their passing.
Pharmacy
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
benefits.
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:
- Medicare
1-800-MEDICARE
(1-800-633-4227)
TTY users should call 1-877-486-2048
Or
for free personalized health insurance counseling contact:
