Current Customers/Customer Service
New Inquiries/General Information
Categories
Learning Center Medicaid Planning

What is Community Medicaid in New York State?

This article is not intended to provide you with legal advice. Should you seek legal advice, please consult an attorney. KTS would gladly recommend an attorney should you need one. It’s important to have an attorney take appropriate actions on your behalf and to avoid issues that may be discussed in this article.

This article has been updated on 3/28/2023 to reflect the latest changes in Medicaid income limits for Community Medicaid.

There are two types of New York Medicaid programs that are available to State residents who require additional medical and non-medical care. In April 2020, the New York State 2020-2021 State Budget that was passed has resulted in changes that will affect New York State residents’ eligibility for Community Medicaid. In order to qualify, an understanding of these changes and their new eligibility requirements is essential.

What is Community Medicaid in New York State?

To put it simply, Community Medicaid is standard health insurance that allows recipients to remain in their communities. Community Medicaid eligibility in NY means providing assistance to seniors who wish to age in place but who require some level of care in order to do so.

This program serves as an alternative to Institutional or Nursing Home Medicaid which provides benefits to residents who need to enter long-term care or skilled nursing facilities. It allows senior citizens to stay in their homes while receiving additional care.

Community Medicaid recipients usually require basic assistance with activities of daily living (ADLs) such as eating, dressing, toileting, bathing, and transferring. Community Medicaid is also available to eligible recipients who are living in Assisted-Living facilities.

What benefits does Community Medicaid provide?

The NYS Department of Health lists the following Community Medicaid benefits and services:

  • Doctor and clinic services, lab tests, and x-rays
  • Medicaid drug coverage for prescription and non-prescription drugs
  • Home care and personal care aides
  • Adult daycare and transportation to medical care
  • Physical, occupational, and speech therapy
  • Mental health services
  • Durable medical equipment, orthotic and prosthetic appliances
  • Light housekeeping

Patients who continue to live at home, as well as residents in assisted-living facilities, may be eligible for these services through Community Medicaid.

What are the eligibility requirements for Community Medicaid in New York?

Since Community Medicaid is a means-tested program, there are specific requirements that must be met in order to qualify for benefits. Firstly, an individual must be aged 65 or older or disabled. There must also be an established need for services. Prior to 2021, an applicant needed to show that they need assistance with at least two activities of daily living (ADLs).

As of July 1, 2021, applicants must show a need for assistance with a minimum of three ADLs. If the individual has an Alzheimer’s or dementia diagnosis, the applicant needs to show they need help with more than one ADL. These ADLs include:

  • Bathing
  • Personal hygiene
  • Dressing (upper body/lower body)
  • Walking/locomotion
  • Transfer to toilet
  • Toilet use/incontinence care
  • Bed mobility – turn and position
  • Eating

There are also personal care tasks that may be factored in when determining eligibility. Examples of Level II personal care tasks include:

  • Administration of medications
  • Preparation of meals with modified diets
  • Providing routine skincare
  • Changing of simple dressings

Also, recipients need to be financially eligible. In order to determine someone’s eligibility, there is an assessment of the applicant’s income as well as assets. The state will review two categories within the applicant’s financials including their income and applicable resources.

In this case, income is considered as any monies generated regardless of the source. This income can include Social Security, wages, pensions, alimony, IRA in distribution, or gifts.

Resources are defined as assets including savings, stocks and bonds, real estate, and IRAs that are not in distribution. Some assets are considered exempt and don’t affect eligibility including IRAs and 401Ks in payout status and irrevocable prepaid burial funds.

The individual’s primary residence is also considered an exempt resource. However, the individual, a spouse, a minor child, or a disabled child must be living in the house. If none of these circumstances apply, in order for the applicant’s home to be considered an exempt resource, the equity in their home must be less than $893,000.

What are the income limits for Community Medicaid in New York?

The limits in the two paragraphs following have been updated on 3/28/2023 to reflect current amounts.

Income limits for Community Medicaid do exist in New York. Currently these limits are $1,677.00 monthly per each individual and for couples the limit is $2,268.00. The disabled, elderly, and/or blind applicants will be entitled to what is called a “disregard” of $20 on any unearned income.

This disregard means it will not be considered or budgeted. When taking this $20 disregard into account, individual income limits are $1,697.00 per month and the couples limit is at $2,288.00 per month. Resource limits are also in place. These limits are $40,820.00 for couples and for individuals is $30,180.00.

What will happen if my income or my assets exceed the allowable limits?

Qualifying in spite of excess income limits is possible. In fact, there is more than one way you can qualify even though you may have income and/or resources that exceed the Medicaid limits. Here are a few ways that may help you to still qualify.

  • Health insurance premiums
  • Pay-in and spend-down
  • Earned income
  • Pooled income trust
  • Holocaust Restitution Payments
  • Spousal Impoverishment Allowance

What is the “look back” period?

Before October 1, 2020, there was no lookback for Community Medicaid. However, due to the passage of the 2020-2021 state budget, a 30 month lookback period will eventually be required. The effective date for the lookback period has been postponed many times due to the Families First Coronavirus Act which forbids states from restricting eligibility for Medicaid benefits during the pandemic.

Upon implementation of the lookback, assets that are transferred since Oct. 1, 2020, will in fact, be subject to the lookback. If the lookback starts May 1, 2022, the lookback period will be 15 months.

The lookback period will increase on a monthly basis until it is 30 months in April 2023. As of now, the lookback will go into effect for Community Medicaid applications that are received beginning January 1, 2022. However, this date has changed multiple times and may be pushed back again.

How did the New York State 2020-2021 Budget change Community Medicaid?

The budgetary changes that have been implemented have the potential to severely disrupt the lives of senior citizens and disabled people living in New York State. For those who wish to age in place and remain in their homes and communities while protecting their assets, careful planning will now be required.

In summary, Community Medicaid is an invaluable program for senior citizens and disabled people who require assistance with activities of daily living but who don’t require the level of care that a skilled nursing facility provides.

About the author, Carlos Nath:

Carlos Nath is the Senior Trust Advisor with KTS Pooled Trust. As a seasoned professional with over four years of experience in the New York pooled trust space, Carlos has helped thousands to enroll and set up their accounts with KTS. He is proficient in understanding the Medicare process and provides assistance in clarifying what clients may need. Previously, Carlos worked with a Medicaid consulting firm as an advisor who helped clients who were seeking Medicaid assistance.

Categories
Learning Center Medicaid Planning

How does Medicaid Estate Recovery in New York Affect You?

This article is not intended to provide you with legal advice. Should you seek legal advice, please consult an attorney. KTS would gladly recommend an attorney should you need one. It’s important to have an attorney take appropriate actions on your behalf and to avoid issues that may be discussed in this article.

In short, if you receive Medicaid long term care benefits from the State of New York, they can claim your property after death. It’s actually a common practice although many benefit recipients may not be aware of the program.

The state is required under Federal law, Social Services Law (SSL) Section 369, to recoup payments to Medicaid recipients 55 years and older. This also includes recovering payments made for institutionalized care (assisted living) under the Medicaid program. Whichever one of these two situations occurs first (55+ or inpatient care) would mark the beginning of what needs to be recovered.

Many older adults who qualify for Medicaid have to spend down their assets to cover their care. Medicaid eligibility requirements are very clear about what is needed to qualify and receive benefits for long-term care costs.

As a Medicaid beneficiary, you are required to spend everything you have (income and assets) on your long term care needs. However, you may still keep your home, and doing so will not prevent you from receiving needed benefits. Sometimes, elderly, who may be expected to return home at some point, are wise to maintain ownership.

Seizing your assets and real property.

But upon your death, the state will step in to recover whatever they can from your estate. Recovery can include seizing your bank account or other liquid assets to help recoup benefits paid for long-term care services. A recent article in US News reviews a number of cases in which states sought recovery of long-term care costs of recently deceased parents, from their surviving children.

A lien or property sale by the state will ensure payment for benefits paid to you while you were alive. This includes your home (real estate) that you own. Such actions would take place during the administration of your estate process. These procedures could, in some cases, also extend to those who may have received assets from the estate.

Delaying the estate recovery process.

Recovery by the state could be deferred in spite of a lien on the property. This deferral could include a survivor/heir legally residing in the home prior to the Medicaid recipient’s death and don’t want to sell. In addition, unless the property is sold, the Medicaid claim can’t be paid in full.

If survivor/heirs can demonstrate the inability to get financing to pay the estate claim, recovery may be delayed. This is also true if survivors/heirs agree to pay Medicaid the claim amount within a reasonable payment schedule and reasonable interest.

Assets included in the state Medicaid recovery program.

So, what exactly may be included in Medicaid’s estate recovery program? In this case, under 18 NYCRR 360-7.11, the estate of an individual includes whatever you have a legal title to at the time of death.

This also includes anything that you have an ownership interest in upon death. The list includes real property such as your home, land, buildings, and any personal belongings/property. In addition, it includes your other assets that are passed on to your heirs, whether or not you have a will.

Regarding an individual’s interest, your estate would include assets conveyed to your survivor or heirs. This would also include anything assigned through survivorship, joint tenancy, tenancy in common, living trust, life estate, or other such arrangements.

Any jointly owned accounts with financial institutions, life estate interests, jointly held real estate property, interest in certain annuities, and trusts would also apply. This is regardless of whether or not there is a right of survivorship or a named beneficiary.

When is recouping Medicaid benefits not allowed?

Are there any situations in which this recovery law is not allowed? There are some situations that do prevent actions from being taken by the state. These would include surviving dependent family members such as your spouse, disabled or blind children.

If your spouse, for example, is still alive, no action would be taken until their death. In addition, any resources, income, and property that belongs to an Alaskan Native or American Indian is not allowed as detailed in 02 OMM/ADM-3.

As mentioned previously, there are situations that may qualify for what is called “deferred recovery.” Minor children who live in the home qualify and would therefore defer any recovery against your home.

Other instances of deferred recovery include an adult child who resided in the home at least two years immediately before the recipient was moved to long-term care. In this case, your adult child would have provided care that may have delayed the need to be institutionalized. In addition, they would have needed to lawfully reside in your home on a continuous basis. Recovery, in this situation, can only take place if your adult child no longer lives in the home or if it’s sold.

If you had joint ownership rights with a sibling who shares the home, the state may delay recovery. In addition, in cases of undue hardship, the recovery of your estate may be delayed.

Does Medicaid ever waive this program?

Are there any instances when Medicaid estate recovery can be waived? Waiving this type of estate recovery may be requested by your surviving heirs or beneficiaries in cases of undue hardship. Such requests would need to be made within 30 days of a Medicaid estate claim notification.

What constitutes undue hardship? When your asset is the only form of income such as a family business and such income is limited, undue hardship may exist. Other considerations would be if the property is the primary residence of the beneficiary and is of modest value. Modest value is determined if, at the time of death, the real property’s value is no higher than 50% of average selling prices within the home/property’s county where it’s located.

There may be other situations due to undue hardship that the state may consider in waiving recovery. However, there are instances when the claim of undue hardship does not result in waiving estate recovery. For example, a beneficiary may claim they are no longer able to maintain a certain type of pre-existing lifestyle. Such a case has been consistently determined not to be among the circumstances in which recovery is waived.

The cost of long-term care could be your home.

Learning about this recovery law for the first time may be disturbing to many elderly people hoping to leave something for family members when they die. For example, if recovery is not waived, it may thwart plans for many seniors planning to leave their homes to their loved ones. For this reason, you may want to consider protecting your assets through early estate planning and asset protection.

About the Author, Carlos Nath:

Carlos Nath is the Senior Trust Advisor with KTS Pooled Trust. As a seasoned professional with over five years of experience in the New York pooled trust space, Carlos has helped thousands to enroll and set up their accounts with KTS. He is proficient in understanding the Medicaid process and provides assistance in clarifying what clients may need. Previously, Carlos worked with a Medicaid consulting firm as an advisor who helped clients who were seeking Medicaid and pooled trust assistance.

Categories
Learning Center Medicaid Planning

Can a Homeowner Qualify for Medicaid in New York State?

This article is not intended to provide you with legal advice. Should you seek legal advice, please consult an attorney. KTS would gladly recommend an attorney should you need one. It’s important to have an attorney take appropriate actions on your behalf and to avoid issues that may be discussed in this article.

Many New York residents may not know if they are eligible for New York Medicaid if they own their own homes. To find out, you’ll need to explore the eligibility requirements for Medicaid for individuals who own their own homes, commonly referred to as “the homestead.”

It’s important to understand the different types of Medicaid available to New York residents. You’ll also need to know what assets are looked at in determining Medicaid eligibility. In addition, learn how you can protect your assets if you decide to apply for and take advantage of Medicaid benefits.

What is Medicaid?

Medicaid is a joint state and federal government benefits program that provides health care insurance to people with limited income and assets. More than 70 million Americans have taken advantage of Medicaid benefits at one time or another to help with unexpected healthcare costs. It is a social services assistance program that works.

But what exactly does limited income and assets mean? Will you qualify for Medicaid if you are a homeowner? What about other assets such as a car, money in savings bank accounts, retirement plans, IRAs, or life insurance policies?

There are many types of assets and income to consider. Therefore, understanding the rules that apply for the different kinds of Medicaid is essential.

Chronic Medicaid Option

The two main types of Medicaid program coverage that senior citizens who reside in New York apply for are Chronic Medicaid and Community Medicaid. Chronic Medicaid is for people who require long-term care or people who can no longer be cared for safely in their own homes. In other words, home care is not an option. To be eligible for Chronic Medicaid, individuals must be residents of New York State and fall into one of three categories: they must be 65 years old or older, blind, or disabled.

Many people mistakenly assume that their Medicare benefits will help with the costs of skilled nursing. But Medicare benefits do not provide any coverage for long-term care facilities. It is not that type of health plan. For seniors who do not have long-term care insurance, they will either need to apply for Medicaid or pay for these expenses out of pocket.

As you can imagine, the costs of a skilled nursing facility add up quickly. And many families have had to deal with the double whammy of these unexpected costs along with the failing health of their loved ones.

Community Medicaid Option

Another option is Community Medicaid, which allows recipients to remain in their communities, either in their own homes or in Assisted-Living facilities or assisted-living communities. This aptly named option provides assistance to seniors who wish to age in place. But these seniors require some level of care in order to do so.

Community Medicaid recipients usually require basic assistance with activities of daily living (ADLs) such as eating, dressing, toileting, bathing, and transferring. Benefits may include a personal care aide or community-based programs that can help an individual remain in the home. So, home care services are a key aspect of community Medicaid.

Determining Eligibility

When it comes to determining eligibility for Chronic Medicaid or Community Medicaid, the rules concerning the homestead are different for each program. For Chronic Medicaid, the rules are much stricter.

For Community Medicaid, so long as the equity value does not exceed the set limit, the homestead is considered exempt and isn’t included in resource calculations. However, the individual’s home is not automatically exempt with Chronic Medicaid.

Let’s dive more deeply into the rules that apply for individuals who own their homes and who require Chronic Medicaid coverage. Here is the specific language regarding homesteads in the New York Codes, Rules, and Regulations regarding exemptions:

According to elder law attorneys, Goldfarb Abrandt & Salzman, “For persons who are 65 years of age or older, certified blind or certified disabled, a homestead loses its exempt status if the owner moves out of the home without the intent to return, and no spouse, child under 21 years of age, certified blind or certified disabled child, or other dependent relative is living in the home.”

On the other hand, if the individual’s spouse is living in the home, the homestead could be exempt. Or if a minor/disabled/caretaker dependent resides in the home. If the individual doesn’t meet these requirements, the other big part of this equation is the individual’s intention to return to the home after their stay in the long-term care facility.

Intent to Return Home

The intention of an individual to return home is subjective and depends on each individual homeowner’s situation. The intent to return home can be written in the form of a signed statement/letter or an affidavit. A letter or affidavit may also be written and signed by the individual’s friends or family if they possess personal knowledge of the intent to return home.  Goldfarb Abrandt & Salzman says that, “When these circumstances apply, the subjective intent to return home holds, even if there is the possibility or expectation that the individual will not be discharged and return to the home.”

A lien can be placed on the home by the state even though the individual is still alive. This may be the case if the individual is considered “permanently absent” and no discharge is reasonably expected. In such cases, the lien can be imposed even when the individual has a subjective intent to return home.

However, if certain occupants reside in the home, the state is not able to impose liens. These occupants include the individual’s spouse, a minor child who is either blind or disabled, or a sibling with equity interest. The sibling must also have lived in the home for a required minimum amount of time prior to the individual’s admission to the nursing home.

Medicaid application strategies for homeowners

If you are a senior citizen or disabled person in need of coverage through Medicaid and you own your own home, don’t despair. Having large assets such as a home does not automatically disqualify you for Medicaid coverage. Familiarizing yourself with the eligibility requirements early on is crucial.

Find an elder-law attorney who specializes in asset protection and Medicaid planning strategies. They can help you and your loved ones prepare an asset spend-down strategy to meet the requirements. Doing so will let you receive coverage without incurring penalties, liens, or estate-recovery tactics.

About the author, Carlos Nath:

Carlos Nath is the Senior Trust Advisor with KTS Pooled Trust. As a seasoned professional with over four years of experience in the New York pooled trust space, Carlos has helped thousands to enroll and set up their accounts with KTS. He is proficient in understanding the Medicare process and provides assistance in clarifying what clients may need. Previously, Carlos worked with a Medicaid consulting firm as an advisor who helped clients who were seeking Medicaid assistance.

Skip to content