Happy Elderly CoupleIn the event the client requires home care or institutionalized care in a nursing home facility, an application for Medicaid benefits may be required. Due to complex asset and transfer rules, a New York application should be made with the aid of an experienced New York Medicaid Attorney. Again, it is useful in this context for a confidential survey of the client's assets, as well as any transfers of those assets, to be filled out prior to the initial consultation. This form of financial survey will be significantly different from the one used for estate planning purposes. As a combined federal and state program, Medicaid asset and transfer rules vary significantly from state to state.
There are two different kinds of Medicaid, Community Medicaid and Chronic Care Medicaid.
Community based Medicaid applications are for low income recipients and any elderly/disabled person who wishes to remain in the community, in the setting of their own home. This benefit requires three (3) months of financial documentation, current proof of income, along with “common documents” and the past year's income tax filing, with 1099's.
Once benefits have been applied for and a Medicaid “pick-up” date has been established, the applicant may keep some of their monthly income and the balance is required to be contributed to their care. The amounts you may retain are constantly changing and are naturally different for singles and couples. Consult with an elder law attorney for the going rates in your community at any given time. There are also a number of methods to keep additional income involving pooled trusts and Special Needs Trusts.
Resources, which are assets belonging to the applicant and/or community spouse, must be reported and an individual is allowed to keep only a modest amount, less than fifteen thousand dollars. If there is a spouse at home, the resource allowance may be as much as one hundred and twenty-five thousand dollars.
Perhaps your loved one may no longer stay at home because they have become a danger to themselves or others. Maybe they need too much care or their caregiver is no longer able to manage their care. In such a case you may want to apply for chronic care benefits.
The Chronic Care application requires a look-back of sixty months. You must provide all financial statements of any open or closed accounts in this time period. Each county is different in the type of documentation you will need to present. Again, all “common documents” must be presented, three years of tax returns, proof of income, and the correct application.
The Department of Social Services will look for any gifts or transfers made in the look-back period (gifts to children, friends, grandchildren, church donations, charitable donations, etc.). Each gift will incur a penalty period determined by the state Medicaid Regional Rates chart published each year. Should you apply before the penalty period has expired you may be asked to provide additional documentation.
On all applications the county will begin an investigation. They will request an IRS report for the past three years, they will request a DMV report to see what vehicles are or were owned, they will request a financial institution report under the applicant's and his/her spouse's Social Security number and if something has not been reported the department may charge the applicant with fraud if they feel a deliberate attempt was made to hide assets.
In our experience, most individuals who attempt to file for Medicaid benefits, without the assistance of counsel, either complete the application incorrectly, do not provide the correct documentation or give unnecessary information which causes the county to investigate further. These types of errors may require an appeal, known as a Fair Hearing, to have the matter rectified.
An individual applying for chronic care benefits and who is in a nursing home is required to pay virtually all of their income towards their care. The community spouse, if there is one, is allowed to keep about three thousand dollars per month in income and, if they fall short, the institutionalized spouse is allowed to contribute some of their income to the community spouse before paying the nursing home.
Frequented Asked Questions
- If I have unpaid medical bills and am not covered by private health insurance, will the Medicaid program pay my bills?
- What are the Medicaid financial criteria for an adult Medicaid Nursing Home recipient?
- What are the Medicaid financial criteria for a non-applying spouse of a Medicaid recipient?
If I Have Unpaid Medical Bills and am not Covered by Private Health Insurance, Will the Medicaid Program pay my Bills?
Medicaid is a joint federal and state program that pays for home health aides, therapies, prescription drugs and hospital and physician's bills. Persons receiving Home Relief or Aid to Families with Dependent Children are eligible for Medicaid. Disabled individuals of any age as well as those who are medically needy under the age of 21 or over the age of 65 are eligible for Medicaid benefits so long as they meet the financial criteria. Medically needy individuals are those whose assets and income do not meet the cost of necessary medical care. The Medicaid program will pay for their medical bills once they have spent their assets and/or income which exceed the Medicaid financial criteria on medical bills.
A Medicaid recipient may retain $4,350 (1/1/08 - 3/31/08) and $13,050 (4/1/08) in resources in addition to a homestead in which he or she resides and a car. Income above $50/month must be contributed to the cost of nursing home care.
If the Medicaid recipient resides in a skilled nursing facility or receives waivered home care services described below, the spouse may retain $2,610/month in income and resources of between $74,820-$104,400. If the spouse's income is below $2,610/month after the Medicaid recipient's pension and social security has been allocated to the spouse, then he or she may apply for an enhanced resource allowance in order to generate the income necessary to bring monthly income to $2,610/month. Spouses with assets greater than these may consider planning options such as transferring excess resources or refusing to make these resources available for the support and maintenance of the ill spouse.