NYS Medicaid

NYS Medicaid

This is one topic I really didn’t want to discuss but I know I can’t avoid. First let me explain I’ve handled Medicaid applications for my job for 13+ years before I stopped working.  I know the NYS Medicaid long term care system well.

I should back up an explain Medicaid. There are two types of long term Medicaid.  One called chronic care and one called community care.  The chronic care is for someone in a rehab or nursing facility that requires a 5 year look back period of ALL bank accounts and any investment accounts. All income less $50 will be turned over to the nursing home or rehab facility in most cases. Total assets cannot exceed $14,880. In this Medicaid process what they are looking for is large deposits and/or withdrawals.  Any of these deposits or withdrawals must be explained and proved. The real issue here is when you gift. Gifting is bad for Medicaid it causes penalties.  Let’s say mom gave her son $12,000 towards a downpayment on his house 3 years ago. Medicaid takes that $12,000 divides it by the average New York State assessment (roughly $12,000 a month) and there is a 1 month penalty. What that means, for 1 month Medicaid WILL NOT pay for mom’s services.  What that means for you, the nursing home doesn’t get paid and they are coming after SOMEONE.  Not good but if there were no penalties all is good.  There are of course other factors with eligibility but banking usually is the biggest issue.

The community based Medicaid is when you live at home.  This is a 3 month look back. Meaning as in the last example if mom gave her son the money for his house downpayment, as long as it’s not on the bank statements in the last 3 months no penalties occur.  Here the issue is income.  Your income cannot exceed $825 for an individual or $1209 for a family of two.  Assets still can’t exceed $14,880.  Well now the problem is who can live on that income on Long Island with those kind of incomes? There is such a thing as a pooled trust approved by Medicaid that acts as another bank account that you deposit your income overage in to exempt it.  Let’s show the example. If you get $1525 in income each month the allowance is $825, your overage is $700.  If you had a Medicaid approved pooled trust you’d deposit your $700 in there each month and that money now becomes exempt thus making you eligible for Medicaid benefits. Again the assets eligibility and other eligibility requirements have to be met but I wanted the basics of Medicaid to be laid out.

The reason I decided to explain the requirements for Medicaid is because many of us are on or will eventually need disability and there is a 2 year wait to get Medicare.  If you are not married you need to have health insurance.  Most people don’t understand the system, don’t think they qualify or think they need a lawyer.  If any one has any questions please reach out to me I’ll be very happy to help.  I do NYS unfortunately each state is different but I can help anyone for New York


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