New York Medicaid Long Term Care Eligibility

New York Long Term Care

Program Overview

new-york-medicaid New York State provides a robust Medicaid program for those needing long term care. Many New Yorkers receive care either in their home or in a residential care facility, such as a nursing home or assisted living community.

Long term care programs have different qualification standards than other Medicaid programs as a result of the Affordable Care Act. As there are now three different financial qualification standards in New York for Medicaid programs, it is important to remember that the MAGI standard (from Medicaid Expansion) does not apply to long term care program qualification in New York.

Services Offered

For long term care services, you must generally fall into at least one of these categories: 65 years of age or older, be disabled and eligible or receiving supplemental support from the Social Security Administration, or have a diagnosis of blindness.

Medicaid services divide into two categories, residential care and community based services.

Residential care is provided either in a nursing home or assisted living community, though the vast majority of New Yorkers who receive assistance from Medicaid are in nursing homes rather than assisted living homes.

Medicaid can also help with community based programs. These include traditional personal care, home health care; Medicaid managed long term care, and mental health adult day care. These programs are less costly and allow patients to remain at home.

Both programs are designed to provide assistance to those who need help with the activities of daily living, such as bathing and other personal hygiene tasks, as well as running errands and grocery shopping, for those who are homebound and without a family caregiver.

Evaluations are made by county based offices. They will make the determination whether or not a person needs long term care based on their need and by contacting their providers.

General Eligibility Requirements

Most long term care applicants will be either disabled, aged 65+, or have diagnosed blindness. As such, they will be subject to the Non-Magi (Modified Annual Gross Income) standard, essentially the pre-affordable care act standard.

3. Income Limitations – if single, the applicant’s income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $825.00 per month ($1,209 per household if a couple needs care).

  • There is a personal needs allowance of $50.00 per month, which is not factored into the total income, for the person receiving long term care services.

4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away.

new-york-long-term-care

Exempt Assets for an applicant in New York include:

i. $14,850 or less in cash/non-exempt assets if single. If the assets exceed the limit on the first of the month the applicant is ineligible for the entire month. If married and both spouses reside in a nursing home, the asset allowance for a couple is $21,750.00.

ii. One home is exempt (equity limit $840,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.

iii. One car, no equity amount specified.

iv. An irrevocable funeral trust, no amount specified.

v. Life insurance policy if the face value of said policy is $1,500 or less.

vi. Household goods and personal effects, i.e. jewelry, furniture, heirlooms, etc.

Spousal Rules:

Amount of income community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $120,900. If the community spouse’s assets do not equal the minimum of $74,820, the community spouse is able to retain assets from the institutionalized spouse until the minimum is reached.

Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse’s monthly income is less than $3,022.50. The community spouse may retain a maximum of $3,022.50 per month.

New York long term care insurance partnership:

This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.

Further Reading:

New York Medicaid Information- New York Department of Health
Contains information about New York’s Medicaid programs, including how and where to apply: http://www.health.ny.gov/health_care/medicaid/#apply

Financial Information for Applicants
Medicaid informational reference: http://www.nyspltc.org/medicaid/

Information about Personal emergency Response Systems (PERS)
Many New Yorkers are unaware that PERS systems can be paid for by Medicaid. For those thinking of getting an alarm in home, or who already have one, Medicaid may be able to take care of your system: https://www.primemedicalalert.com/states/new-york-medical-alert-systems/

Long Term Care Ombudsman
For those who need information about benefits, providers, or have questions, the Ombudsman can be a valuable resource. They can also help with any complaints you might have about a care provider: http://ltcombudsman.ny.gov/

Managed Long Term Care
Enrollees who use both Medicare and Medicaid must enroll in a managed long term care program (MLTC). An overview of the MLTC service can be found in this department of the health guide: http://www.health.ny.gov/health_care/medicaid/redesign/docs/mltc_guide_e.pdf