For those navigating healthcare services, especially for older adults in need of long-term care, understanding Medicaid eligibility can be a game-changer.
Here’s what you should know—even if you think you couldn’t possibly qualify.
Traditional Medicaid is typically for people of any age with very low income and no other insurance. In New York State, it’s accessible through the online marketplace. Generally, this is not used by aging adults who have Medicare or other insurance.
For this discussion, we will only address Community and Institutional Medicaid.
Community Medicaid covers long-term care in various settings, including one’s own home, a family member’s home, or an assisted living residence.
Institutional Medicaid covers long-term care in nursing homes, including extended stays with the potential for returning home.
Asset Limits
Both Community and Institutional Medicaid have asset limits, including “countable assets” such as bank accounts, the cash value of life insurance policies owned by the applicant, and properties other than the primary residence (which is excluded). The current limit to qualify is $31,175. Retirement accounts are excluded (Yes, they are!) if appropriate monthly distributions are taken.
Income Limitations
For institutional Medicaid, if unmarried, 100% of gross monthly income may be required to be paid to the nursing home. If married, spousal income can impact contributions to nursing home costs. Under Spousal Impoverishment rules, if the spouse not needing care (the community spouse) earns less than $3,853 per month, Medicaid will allocate enough income from the institutionalized spouse to bring them up to this limit. If the community spouse earns more than $3,853, they can keep their income but will lose 100% of the institutionalized spouse’s income under spousal refusal.
For Community Medicaid, the income limit for an individual is $1,732 per month or $2,351 for a couple who are both seeking coverage. Being over the limit does not mean you cannot qualify. Your income above the limit can be protected via a Pooled Income Trust. Because of these trusts, most people can qualify for Medicaid in New York—despite being over the income limits.
Once you have Community Medicaid, you need to access your services through one of these home care programs:
Managed Long Term Care Plan (MLTC) is the mainstream program through which Medicaid recipients access home care. Unfortunately, due to the pay structure set up by New York state, they provide limited hours of service.
Other programs, such as the Immediate Need Program or the Nursing Home Transition and Diversion Program (NHTD), may offer more services, albeit with complex navigation.
Grasping the nuances of Medicaid eligibility and coverage options for those seeking long-term care services is complex but doable. And don’t be afraid to ask for help!
Colin Sandler, LCSW, CCM, is owner of Medicaid Solutions, 2127 Crompond Road, Cortlandt Manor, NY. She has been providing advice on aging to seniors and their families for over 20 years. Email her at Colin@Medicaidsolutions.com or call 914-924-2566
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17 Apr 2024
0 Commentsunderstanding medicaid
For those navigating healthcare services, especially for older adults in need of long-term care, understanding Medicaid eligibility can be a game-changer.
Here’s what you should know—even if you think you couldn’t possibly qualify.
Traditional Medicaid is typically for people of any age with very low income and no other insurance. In New York State, it’s accessible through the online marketplace. Generally, this is not used by aging adults who have Medicare or other insurance.
For this discussion, we will only address Community and Institutional Medicaid.
Community Medicaid covers long-term care in various settings, including one’s own home, a family member’s home, or an assisted living residence.
Institutional Medicaid covers long-term care in nursing homes, including extended stays with the potential for returning home.
Asset Limits
Both Community and Institutional Medicaid have asset limits, including “countable assets” such as bank accounts, the cash value of life insurance policies owned by the applicant, and properties other than the primary residence (which is excluded). The current limit to qualify is $31,175. Retirement accounts are excluded (Yes, they are!) if appropriate monthly distributions are taken.
Income Limitations
For institutional Medicaid, if unmarried, 100% of gross monthly income may be required to be paid to the nursing home. If married, spousal income can impact contributions to nursing home costs. Under Spousal Impoverishment rules, if the spouse not needing care (the community spouse) earns less than $3,853 per month, Medicaid will allocate enough income from the institutionalized spouse to bring them up to this limit. If the community spouse earns more than $3,853, they can keep their income but will lose 100% of the institutionalized spouse’s income under spousal refusal.
For Community Medicaid, the income limit for an individual is $1,732 per month or $2,351 for a couple who are both seeking coverage. Being over the limit does not mean you cannot qualify. Your income above the limit can be protected via a Pooled Income Trust. Because of these trusts, most people can qualify for Medicaid in New York—despite being over the income limits.
Once you have Community Medicaid, you need to access your services through one of these home care programs:
Managed Long Term Care Plan (MLTC) is the mainstream program through which Medicaid recipients access home care. Unfortunately, due to the pay structure set up by New York state, they provide limited hours of service.
Other programs, such as the Immediate Need Program or the Nursing Home Transition and Diversion Program (NHTD), may offer more services, albeit with complex navigation.
Grasping the nuances of Medicaid eligibility and coverage options for those seeking long-term care services is complex but doable. And don’t be afraid to ask for help!