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Medicaid Eligibility Rules

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MEDICAID IS NOT MEDICARE:
  New York State Medicaid should not be confused with the Federal "Medicare Program".  Unlike Medicare, which is available to nearly anyone 65 years or older, Medicaid is a program funded from 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 with 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.

 

Click here to read more about the New Medicaid Home Care Penalty Transfer Rules --- effective October 1, 2020.

2021 Medicaid Income Limit For Home Care 
 This is a general explaination - a complete explaination of how the Medicaid program works is provided at a full Medicaid planning consultation. 
   
Single Person receiving home care: $884 (+$20 exemption)
Couple both receiving home care: $1,300 (+$20 exemption)
*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 $884) 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 not covered by the Medicaid program.

 
2021 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.
 

Transfer Penalty Rules
Currently 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  eligible for community home care services the next month. However, after October 1, 2020 there will be a new eligibility waiting period imposed on home care applicants. *Implementation of the new look-back for home care services has been postponed unitl April 2021.
 
2021 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 : $3,259.50 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 $130,380  -- 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 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:

** 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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