Long Island Elder Law & Estate Planning

Medicaid requirementsUnderstanding Medicaid requirements is important because the majority of seniors who get nursing home care throughout the country turn to Medicaid to pay for nursing home bills.  A Hauppauge Medicaid planning lawyer can help you to understand NY requirements

What are Medicaid Requirements for Nursing Home Coverage?

Medicaid requirements, and the Medicaid application process, differ when you apply once you are 65 or older as compared with younger people who are applying.

While non-pregnant adults between the ages of 19 and 64 should apply to the New York State of Health Marketplace, the New York Department of Health indicates that people 65 and older should apply with their Local Department of Social Services (LDSS). Individuals applying for Medicaid coverage for community-based long-term care services should also apply with their LDSS.

Individuals 65 and older who are not parents, caretakers, blind, or disabled will also submit a different application to qualify for Medicaid. They are considered Non-MAGI eligibility groups, with MAGI standing for modified adjusted gross income. Those who qualify as part of a non-MAGI eligibility group will be required to submit:

  • A valid social security number and date of birth. The Social Security Administration (SSA) may verify immigration status. If it does not, proof of immigration status will be required.
  • Proof of age, such as a birth certificate, unless SSA verifies age.
  • Four weeks of recent pay stubs to provide proof of income, if you are working.
  • Proof of income from Social Security, Supplemental Security Income, and Veteran’s benefits.
  • Proof of residence, such as a mortgage or landlord statement.
  • An insurance benefit card, if one is available.
  • A Medicare benefits card.
  • Bank account information and details on other resources, if you are applying to have nursing home care covered.

The purpose of requiring proof of income and assets is to ensure you meet Medicaid’s financial criteria. Medicaid is supposed to be limited to people with limited income. For those with a family size of one, for example, the maximum income you may have to qualify for Medicaid as an individual over 65 is $825. A family of two may have $1,209 per month in income. The chart on the website of the Department of Health lists maximum incomes for different household sizes.

Medicaid is also concerned about whether you have financial resources which could be tapped into to pay for nursing home care. For a family of one, the maximum level of resources you may have and still qualify for Medicaid is $14,850. For a family of two, resources up to $21,750 are permitted.

Many senior citizens have resources which are above these levels. If you have been saving money for retirement over the course of your life, for example, it is very likely you will have in excess of $14,850 in property, money, and assets. You likely want to leave this money to your loved ones, rather than having to spend it on nursing home care.

Medicaid planning can allow you to protect assets while still meeting Medicaid’s qualifying requirements. If you create and carry out a Medicaid plan at least five years before you must get nursing home care, you can take strategic steps like transferring assets to a trust so you do not have money and property in your name that counts when determining eligibility for Medicaid. Your property will be safe and you can get Medicaid to pay for a nursing home sooner.

The process of Medicaid planning needs to start five years prior to the time you require nursing home care because of Medicaid’s five year lookback rule. If you transfer assets (which is part of Medicaid planning), there is a period of disqualification. The disqualification is equal to the number of months reached by dividing the value of assets transferred by the average monthly cost of nursing care in your area (for example, if you transferred $10,000 and nursing homes cost an average of $5,000 a month in your area, you would be disqualified from Medicaid coverage for a nursing home for two months).

You can still protect some assets if you have waited too long, but acting sooner is best. Medicaid.gov also explains that states are required to try to recover Medicaid money paid out from the estates of people who qualified for benefits when 55 or over. Your money and property could thus be taken from your estate after you die if Medicaid pays for nursing home care. Medicaid planning also allows you to prevent this.

How Can a Medicaid Planning Lawyer Help?

A Hauppauge Medicaid planning lawyer at Mark S. Eghrari and Associates PLLC can provide you with help protecting your assets and qualifying for nursing home coverage. Join us for a free seminar to find out more about Medicaid planning. You can also give us a call at (631) 265-0599 or contact us online to find out how we can help you.

To learn more, please download our free medicare and medicaid what are the differences in Texas here.

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About Mark S. Eghrari, Estate Planning Attorney

Mark S. Eghrari is an attorney in private practice in Smithtown, New York. He has been in practice since 1988. Mark S. Eghrari provides extensive estate and tax planning services to individuals and businesses. Mr. Eghrari’s primary focus is helping clients avoid probate, minimize or eliminate Federal and State Estate taxes and protect their assets from the high cost of nursing care, if they become ill.