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New York Medicaid Eligibility Requirements For Seniors

What is Medicaid?

Medicaid is a jointly funded, Federal-State health care program for persons who are financially eligible. Medicaid provides care for acute medical needs, rehabilitation, and long-term care at home and in nursing homes. There are also numerous community-based programs, including adult day care, and assistance with local transportation.

Does Medicaid Pay for Long-term Care?

Yes, Medicaid pays for long-term care in a nursing home. In a few states it also pays for long-term senior care in the home. Medicare, on the other hand, does not pay for long-term care.

If I Give Away My House and All My Money Will I Qualify?

That depends. New York applies the 5-year "look back" to applications for Medicaid nursing home care. If you have transferred assets within the look back period, then Medicaid will impose a penalty. The penalty is a period of ineligibility for Medicaid benefits that is based on the amount or value of the transferred assets.

There is no "look back" in New York with respect to applications for community-based Medicaid, including home care. This means that there is no penalty for having transferred assets prior to the application for these Medicaid benefits.

Spouses have a legal obligation to support each other. When one spouse applies for Medicaid and the other refuses support, Medicaid must provide benefits to the ill spouse, but it has the right to seek contribution from the well spouse. The well spouse (also called the "community spouse") is entitled to certain levels of resources (assets) and income that are immune from any claim by Medicaid. Currently in 2011, community spouses are allowed up to $109,560 in resources and $2,739 in monthly income.

If you decide to transfer any of your assets to another person, you should remember that these assets will no longer be in your control. Also, remember that the leading type of elder abuse is financial, many times by a family member. Effective planning is complicated, and it will likely be prudent and useful to consult an Elder Law attorney before taking action. In most cases, a qualified Elder Law attorney will be able to protect all or a substantial portion of your money, property, and investments.

How do I apply?

Applications are available through your state Medicaid program. While there is no requirement that the application be filed by an attorney, you may find it very useful to retain an Elder Law attorney, particularly if planning is needed to help you qualify for benefits. Errors in the Medicaid application, or the failure to include required documentation, can lead to delays or denial of benefits.

How soon will coverage start?

Coverage can usually begin on a "Medicaid pending" basis as soon as you file your application. This means that the home care agency or nursing home will wait to be paid in arrears by Medicaid when your application is ultimately approved (which can take several months). Also, if you were Medicaid eligible prior to the filing of the application, you may be able to obtain reimbursement for health care expenses that were paid out of pocket for up to 90 days.

What is the maximum amount of assets you can have and still qualify for benefits?

In New York, your are eligible for Medicaid if you have no more than $13,800 in resources (assets), and no more than $20,100 for married couples.

To be eligible for community-based programs, you are allowed no more than $787 in monthly income, although an Elder Law attorney can advise you on effective strategies to protect your "surplus" income. If you are receiving Medicaid benefits in a nursing home, your monthly income must be paid to the nursing home and you are allowed to keep only $50.

Does Medicaid long-term care have a limit?

No, Medicaid will pay for long-term care in a nursing home or at home for as long as a senior qualifies for needing the care, even if this means multiple years of care until death.

Medicaid Services

New York State Department of Health New York Medicaid Services

For New York City Department of Social Services, call (718) 557-1399 or toll free (877) 472-8411

For other Counties, see: http://www.health.state.ny.us/health_care/medicaid/ldss.htm