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Medicaid Eligibility Rules

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New York State Medicaid should not be confused with the "Medicare Program".  Unlike Medicare, which is available to nearly anyone 65 years or older, Medicaid is a combination of federal, state and local money which is administered by the state.   Each state has its own Medicaid program, with its own set of rules and regulations.  Medicaid serves poor people of all ages, particularly older people.  In addition, older people who are not poor but have extensive health costs for a long period of time may use up (or transfer away) their assets to a point where they will eventually qualify for Medicaid eligibility.
The New York State Medicaid program is complicated and has many rules and regulations.  Listed below is some basic eligibility information.  If you are considering applying for Medicaid coverage, it is of course best to come in to our office for a full review and explaination of the Medicaid option.
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*Alert Effective 9/17/12 the Medicaid Home Care Program will be converted over to a "managed care" program.  The newly redesigned Medicaid Home Care Program will be referred to as the "Medicaid Managed Long Term Care Program" (generally referred to as the MLTC program).  While the basic eligibility rules will remain the same (see below), the application process and the way home care services are provided will change.  Please go to our page on the "New Medicaid Choice Program and what it means to you" by "clicking" on the link below for further information on this new development. 

 

Click here to go to THE NEW MEDICAID CHOICE MLTC PROGRAM

2014 Medicaid Income Limit For Home Care 
   
Single Person receiving home care: $809 (+$20 exemption)
Couple both receiving home care: $1,192 (+$20 exemption)
*Individuals who exceed these limits may be eligible under the Surplus Income Program (giving it to Medicaid).  Surplus income (over $809) 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 program.
**NEW Married person option - if married and only one is applying for Medicaid home care - couple may be permitted to keep up to $2,931 of their combined income each month (this will require an analysis of the couples monthly income). 
 
2014 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.
 
2014 Medicaid Resource Limit For Home Care
Single Person: $14,550
Couple, both on Medicaid home care: $21,450
**New 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. 
 
Exempt Resources
  • 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;
  • Home remains exempt as long as the applicant or their spouse contine to reside in the home (max. home value of $814,000) *(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 recipient.
** 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 minimum allowable distribution. (note: income from these accounts is not exempt and will be considered countable income)
Exempt 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. 
 
2014 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 : $2,931 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: $117,240 (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.
 
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:

** Click Here to be taken to the New York State Medicaid Program Website for more public information Medicaid.

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To fully understand how to become eligible for Medicaid and how individuals with incomes and resources that exceed the limits described above can apply for coverage, please contact our office to make an appointment for a Medicaid planning consultation.

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