Medicaid Planning

What Is Medicaid?

Medicaid is a federal and state program that pays for nursing home costs for people who meet certain financial and health requirements. In New York, Medicaid also pays for long-term care and health care at home. Our firm helps clients become eligible for Medicaid, while protecting their assets. We also prepare Medicaid applications, which are complex and challenging. 

Medicaid and Medicare are two very different programs. 

  • Medicaid is available to help people with long-term care, including nursing home care costs. It is a means-tested program, and covers the cost of nursing home care for most families.
  • Medicare is a national health program for people over age 65 or who are disabled.

A New York Elder Law attorney provides Medicaid planning to preserve and protect a lifetime of work from the staggering costs of nursing home and long-term care costs, while securing the best possible health care. By implement a plan it is easier to meet the five year lookback. If assistance is necessary more than five years after the plan Is in place, your assets do not count for Medicaid eligibility.

If there is no plan in place and Medicaid assistance is required, there are many strategies that can preserve a substantial portion of your assets while qualifying for Medicaid. Our firm routinely represents clients when the need for is imminent.

New York State Medicaid Planning

Applying for Medicaid is a challenging process and mistakes are financially catastrophic. Most people get into trouble when they attempt to do it themselves without the help of an experienced Elder Law attorney. The concept of “spending down assets” to qualify sounds simple, but it is anything but.

The most common mistake occurs when a family member thinks they can outsmart Medicaid by transferring ownership of the family home to another member of the family or a trusted friend, often  selling the home for dramatically less than its fair market value. But the documentation required in a five-year financial look back reveals these and any other transactions, and then the senior becomes ineligible for Medicaid coverage. When that occurs, the cost of nursing home must be paid by the family or the individual, until the person becomes eligible again.  

The look-back period in New York is 60 months – five years. 

The combined assets of spouses are considered countable for the care of the spouse, regardless of how the assets are titled. When a healthy spouse is at home, called the “community” spouse, some assets are exempt from Medicaid:

  • The home – up to a value of $840,000
  • One automobile
  • Prepaid funeral and burial for applicant and spouse
  • Household furniture, personal items
  • IRAs, 401(k)s and other qualified plans paying out monthly income
  • Annuities paying out a monthly income where spouse is primary beneficiary
  • Medicaid Asset Protection Trust (MAPT)assets
  • A single applicant may own only $15,750 in non-countable assets.
  • Supplemental Needs Trusts for a disabled person under age 65 that have been set up and funded correctly

Assets in a living trust or any revocable trusts, where the person has control over the assets, are treated as countable assets by Medicaid. If you have a living trust or a revocable trust, these accounts need to be restructured so they are non-countable.

Our Firm Helps Seniors and Their Families With Medicaid Applications

In a perfect world, Medicaid planning should be done before it is needed so all options can be explored. However, this is not always possible. Our firm often helps clients when a loved one is already in a nursing home or is about to be moved from a hospital to a skilled care facility. 

There are many different rules for transferring assets based on a family’s situation and the nature of the care required. 

You may have a conversation with a discharge planner at the hospital where a loved one is receiving care, but it will not be the same conversation during a consultation with an Elder Law attorney. The attorneys at Law Office of Stephen J. Silverberg are noted for their experience with Medicaid applications, estate planning and tax law.

Applying for Medicaid is an Exhaustive Process with Intense Documentation

In New York, a single person may have only assets valued at $15,750 in “non-countable” assets to be financially eligible for Medicaid. Their primary residence and select other assets are not included. Those non-countable assets include certain types of life insurance policies and prepaid funeral and burial plots. 

In New York, the Medicaid Asset Protection Trust (MAPT) is used to protect assets.

When Is The Best Time For Medicaid Planning?

Proper asset protection planning that takes place before there is a need to apply ensures there will be more options available. Applying for Medicaid is complex and lengthy, so the more time to plan and prepare to file, the better. Our firm works to quickly complete Medicaid applications so there is no delay of needed care.

The application and qualification process for Medicaid is complex, and even simple errors can cause delays and even result in coverage being denied. The regulations around Medicaid are strict, so it make sense to have the documents prepared by an experienced Elder Law attorney.

Applying for Medicaid requires knowledge of the Medicaid rules, tax and trusts. Our firm has decades of experience in helping families as they seek to assure their loved ones receive the proper long-term care, while preserving a portion their assets which can be used to provide additional care, and provide them necessary items such as clothing, a television set and other similar items that make them feel more comfortable.

An experienced Elder Law attorney can also help ensuring that the person qualifies for the right level of benefits, including selecting doctors and not being left without choices.

What About the Medicaid “Claw Back?”

Concerns about Medicaid trying to recover payment for care from the community spouse after the institutionalized spouse has passed are real. If assets are left to the spouse whose care is being paid by Medicaid, there may be a claim asserted. New York State is following other states that have become more vigilant about recovering assets. Planning for claw back from the estate should be part of Medicaid planning.  

Will Medicaid Pay for Care at Home? 

For a qualified individual able to remain at home, Medicaid will pay for both Community Health Care and Home Care. These are two separate services, both with the shared goal of allowing an individual to stay in the comfort and familiarity of their own home, while receiving necessary services.

Community Health Care is provided by a licensed professional, with a treatment plan created by the treating physician. The care may include monitoring health, managing medication delivery, wound care, physical therapy, speech therapy, etc.

Home Care refers to services to help an elderly person with Activities of Daily Living (ADL). A caregiver, who might be a family member, comes to the home to assist with personal hygiene (bathing/showering, grooming, nail and oral care), dressing, eating, transferring/mobility (moving from seated to standing, getting in and out of bed, waling from one location in the home to another).

Learn how our firm can help you and your family with Medicaid Planning to Plan and Obtain Medicaid Benefits. Call our Long Island Elder Law firm at 516-307-1236.