There seems to be a common misconception that Medicaid coverage has little positive effect on elderly enrollees’ health. In fact, the opposite is true when you realize that this coverage provides the vital benefits that many people including seniors need.
In the fiscal year 2021, Medicaid was the nation’s single largest payer for health care services, processing claims from over 1.5 million providers to the tune of $424 billion in Medicare payments. Definitely beneficial to seniors, approximately 8% of Medicaid enrollees or eligible enrollees were persons over the age of 65 years old (as of April 2020).
Medicaid and seniors in New York
As of year-end 2021, NY Medicaid covered 7.3 million eligible enrollees with comprehensive health coverage for low-income New York residents that included the elderly. Beginning January 2023, New York state expanded eligibility income levels for those 65 and over, individuals with disabilities, and blind persons by raising the FPL (Federal Poverty Level) to 138%. In addition, NY significantly increased the asset maximum limits allowed for long-term Community Medicaid recipients, which allows seniors with financial and medical needs to receive benefits while staying at home.
As evident by the expansion and increasing numbers of enrollees in Medicaid, this health care program plays a critical role to elderly New Yorkers. Medicaid goes beyond emergency services to provide eligible recipients with preventative health care and by improving health outcomes.
How Medicaid helps the elderly in New York
Medicaid coverage is available to qualified individuals through a joint federal, state, and city government program that provides healthcare coverage to seniors over 65, blind, and/or disabled persons. The program is means tested and does require applicants to provide documentation of financial and medical need. Medicaid applicants must also be citizens of the United States or qualified aliens and if applying for New York Medicaid, you must reside in the state.
Coverages vary depending on your category (age, blind, disabled) as well as when and where you apply. Benefits in New York include:
Healthcare Services
- Community/Home Health Care
- Private Duty Nursing
- Mental Health Services
- Preventative Health Services
- Hospital and Emergency
- Diagnostic
- Occupational
- Clinical Services
Additional Healthcare Benefits
- Tuberculosis (TB)-Related Services
- Rehabilitative Services
- Physical Therapy
- Screening Services
- Speech and Hearing Rehabilitation
- Eyeglasses and Optometry Services
- Dentures and Dental Services
- Approved Prescription Medication
Other Services
- Hospice Care
- Case Management Services
- Personal Care Services
- Prosthetic Devices
- Transportation
- Hearing Aids
Why seniors should consider receiving Medicaid’s benefits
Some seniors may think they don’t qualify for Community Medicaid and long-term care reserved for low-income individuals who are over the age of 65 years. Although there are certain income limits, there are strategies to help the elderly and/or their loved ones to qualify for Community Medicaid and long-term home care. This type of coverage allows eligible seniors to stay in their home and “age in place” while receiving health and personal care.
So, if you are a senior or have a loved one who needs and wants to remain in their home while receiving needed care, Community Medicaid may help you in spite of exceeding Medicaid’s monthly income limits.
Gaining Community Medicaid eligibility in spite of excess income
Having excess income can be a problem for many seniors applying for Community Medicaid. The 2023 Medicaid maximum monthly income levels if you are over 65, blind, or disabled is $1,677 for individuals and $2,268 for couples. Note: These income levels are minus the first $20 of income, which is exempt.
But before you dismiss the possibility of becoming eligible for Medicaid benefits due to excess income, you should know that there are ways that can help you get qualified. One way to offset your excess income is to “spend down” the amount over the limit, called a surplus, by paying this excess to Medicaid. Unfortunately for some, this leaves individuals who receive Community Medicaid without the means to pay other daily living expenses.
For many, the preferred strategy to avoid this “spend down” requirement is to join a Pooled Trust. Doing so will allow members of the trust to deposit their excess income into their account, which is managed by the pooled trust and in turn pays members’ monthly bills on their behalf. This successful strategy helps seniors become eligible for Community Medicaid, receive home care benefits, and provides a means to pay their monthly living expenses.
How can I get help to become eligible for Community Medicaid?
If you find yourself unable to qualify for Medicaid benefits that allow you to receive care at home, you should get help from your elderly care attorney or contact KTS for a free consultation. KTS Pooled Trust is here to help you qualify for long term care coverage at home without having to spend down your excess income.
