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Be sure to review whether you need to purchase Medicare Part D to help pay for drugs. If so, please LIKE our Facebook Page by clicking here or sign up for our newsletter. Breaking News: New York will apply new Medicaid budgeting rules for home care. New York Medicaid applicants should be positive that all eligibility requirements, which are covered in detail above, are met prior to submitting an application for benefits.

However, if only one person needs Medicaid it is usually advantageous for that person to apply on his or her behalf alone; the non-applying spouse must refuse to contribute his/her resources or income to the applicant’s medical needs (“spousal refusal”). Transfers between husband and wife should take place before the sick spouse goes on Medicaid. Fortunately, the new rules have left spousal refusal untouched. Sometimes, seniors find themselves in a delicate situation where the state considers them too wealthy to qualify for Medicaid but unable to pay for vital nursing and hospital care on their own. While this may seem like a practical idea, application for Medicaid in New York requires seniors to disclose asset transfers over the previous five-years to ensure applicants are truly in need of government assistance. All resources held by either spouse shall be considered available to the institutionalized spouse to the extent the value exceeds the Community Spouse Resource Allowance (CSRA). Estate Planning Medicaid Asset Transfers: What Are The Rules? Federal rules state that to qualify for Medicaid nursing home coverage, a person must have no more than $2,000 in “countable” assets. It is the number of months that is calculated by dividing the value of the property transferred during the previous five years (or 2 1/2 years for home care) by the average cost of nursing facility services in that area of the state. To avoid ineligibility and penalties, it is important to plan ahead. Please try again. The Medicaid applicant may freely transfer his or her home to the following individuals without incurring a transfer penalty: Congress has created a very important escape hatch from the transfer penalty: the penalty will be "cured" if the transferred asset is returned in its entirety, or it will be reduced if the transferred asset is partially returned. It is available to persons who are eligible for public assistance or SSI (Supplementary Security Income). Living Trusts & Wills The CSRA level for 2020 is $74,820 or one-half the couple’s resources as of the date of institutionalization to a maximum of $128,640. For example, in New York State transfers/gifts will not disqualify you from receiving community-based care including home health care, but will cause a disqualification period for nursing home care. The Medicaid agency must grant benefits, but reserves the right to pursue the non-contributing spouse for support in family court. Transferring assets to certain recipients will not trigger a period of Medicaid ineligibility. (212) 490-2020 Phone To calculate the penalty period, applicants must divide the total value of assets transferred by the regional average monthly cost of private nursing facilIty services, available from the New York Department of Health. Your comment has not yet been posted. Special Needs Planning, by Michael S. 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New York, New York 10017 The income of the community spouse is not deemed available to the institutionalized spouse. A home is exempt if transferred to one of the following: Certain other transfers of any resource are also exempt. If you are interested in learning more about Medicaid asset protection, go to www.pierrolaw.com and take advantage of our Guides and watch our most recent webinar here. But Medicaid will not be reduced if this amount is not paid. Don’t make a mistake with Medicaid eligibility; contact a New York elder law attorney with knowledge of Medicaid law. The penalty period created by a transfer within the look-back period does not begin until (1) the person making the transfer has moved to a nursing home, (2) he has spent down to the asset limit for Medicaid eligibility, (3) has applied for Medicaid coverage, and (4) has been approved for coverage but for the transfer. A trust for the sole benefit of a disabled individual under age 65 (even if the trust is for the benefit of the Medicaid applicant, under certain circumstances). Check with your elder law attorney.

In 2012, a Pennsylvania appeals court found a son liable for his mother's $93,000 nursing home bill under the state's filial responsibility law. L. § 366 (5)(e)(4)(i). Applicants who transferred assets during this new lookback period will face a period of ineligibility when Medicaid will not be available to them. If the community spouse has more than $3,216 in income per month, then Medicaid will suggest that he/she contribute 25% of the excess over $3,216 to the institutionalized spouse’s medical care. Medicare Part B is optional and covers part of physicians’ costs and other medical services and supplies. The state Medicaid agency then determines whether the Medicaid applicant transferred any assets for less than fair market value during this period. Medicare Part C is managed care whereby insurance companies or medical providers have contracted with the Federal Government to provide comparable coverage without some of the deductions of Medicare, but with a specific network of approved providers. Under these Medicaid rules, an “institutionalized spouse” includes not only a person in a nursing home, but a person in a hospital who is expected to remain in such a facility for at least 30 consecutive days. Medicare Parts A & B —“Traditional Medicare”. As an alternative to spending down, New York permits Medicaid recipients living in the community and certain congregate care facilities to protect all their income by the use of trusts for income (see below). As a result of this new delay, there is a short period between now and March 31, 2021, where planning can be done and applicants can begin service without the new penalty or other stringent rules. Thus, one can transfer assets (make non-exempt transfers/ gifts) on or after October 1, 2020, without any penalty and/or lookback period IF they apply for home care Medicaid before April 1, 2021. This is a devastating turn of events for New York’s seniors and disabled. Effective for eligibility periods beginning on or after January 1, 2010 FHPlus and non-SSI-related Medicaid A/Rs will not have resources considered in determining eligibility. The Medicaid resource limit for a single person in New York State for 2020 is $15,750. Purchase a Medigap Policy If You Have Traditional Medicare In this situation, the community spouse has a maximum threshold of &74,820 to $119,220 ($14,850 for the institutionalized person and $119,220 for that person’s spouse). Mr. Enea is the Past President and Founding member of the New York Chapter of the National Academy of Elder Law Attorneys (NAELA).

However, income will first be transferred from the institutionalized spouse to the community spouse before additional resources will be allowed. From his/her own income the nursing home resident retains a personal needs allowance ($50 per month) and must spend down his/her remaining income on medical care. If I Want to Protect My Home For Long Term Care Purposes What Are My Options? However, “undue hardship” is difficult to establish. Under Federal Law, Medicaid recipients may join a not-for-profit pooled income trust to protect monthly income above $895 so it can be used to pay the Medicaid recipient’s bills. Medicare is a federal program available to persons who are sixty five years of age and older, and disabled persons of any age who receive Social Security Disability benefits. He is the current Chair of the 50+ Section of NYSBA.

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