pitfalls of applying for medicaid

New York State Medicaid is a government assistance program. You would think it would be relatively easy to access. Unfortunately, this is not the case. If you are trying to access Medicaid for long term care at home, there are three major areas where things can easily go wrong: assets, income and accessing home care.

First, in order to qualify for community (at home) Medicaid, you need to meet two requirements: an asset cap and an income cap.

What does Medicaid consider an asset? An asset is considered any real property in the applicant’s name as well as financial property such as checking and savings accounts, CDs, investments, annuities, 529 accounts, stocks, bonds, retirement accounts, life insurance, etc.

Your primary residence can be exempt, but is at risk for loss upon death if not titled properly.

Retirement accounts and some annuities can be exempt, but you must be taking regular disbursements from them.

Life insurance cash value is an asset and can disqualify you if not properly addressed.

A Medicaid professional can help ensure your assets are properly positioned – based on the type of care you’re looking for, while also being prepared for possible future issues.

What does Medicaid consider income? Income is Social Security, pensions, retirement income (IRAs and 401Ks), workers comp, VA benefits, rental income, financial assistance from family or friends, and so on.

The only exemption on your income is any “out of pocket” health insurance premiums. Otherwise, they do not consider your monthly living expenses when determining eligibility.

In some cases, being married can resolve the issue of having too much income as there are some special rules here.

The only way to protect income over the limit is via a pooled income trust. Medicaid requires additional paperwork to process this type of application. If not done properly, the trust (even if it is set up and funded) may not be acknowledged by the Medicaid office.

Your Medicaid is approved. Now, how do you get home care? This, too, is not a consumer-friendly process. Everyone who wants long term home care must choose a Managed Long-Term Care Plan (MLTC). Medicaid requires an assessment from a State nurse before you can enroll in a MLTC plan. This first assessment is not a determination of hours you will receive, but simply a screening required before you an MLTC evaluation. Understanding how MLTC companies determine hours, enrollment deadlines and contacted agencies can also be critical to your plans.

Lack of information and an application not properly completed can cause significant delays in accessing Medicaid covered home care. A Medicaid specialist can help with all the potential issues and be more effective in getting the services your loved one needs to stay at home.

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