Finkel & Fernandez, LLP

Medicaid is a government health insurance program which assists people with low income and resources getting and paying for medical care. Medicaid benefits include a full range of health care services, home care and institutional care services, many of which are not provided by Medicare. Home care, long term nursing home care, physicians, dentists, inpatient services, outpatient services, physical therapy, occupational therapy, prescription drugs, dentistry, eye glasses, hearing aids, medical supplies, and a myriad of services may be covered by Medicaid if the services are medically necessary and the recipient is eligible.

Individuals applying for Medicaid must prove that they meet certain requirements including citizenship or legal United States resident status. The applicant must apply in the state and county where he/she resides, defined as physical presence and the intent to remain permanently or indefinitely. If you have too much income and/or resources you will not qualify for Medicaid, even if you are disabled. In 2016, for a single individual, the New York State resource limit is $14,850 and the income limit is $825.00 per month (plus a $20.00 month disregard in New York City). Some resources are not counted by Medicaid in determining your eligibility for benefits. Exempt resources include your primary residence (subject to an equity cap of $828,000 in 2016 in New York), one car, burial allowance of $1,500, burial space, prepaid irrevocable funeral trust, personal belongings, furnishings, jewelry, some qualified retirement accounts and annuities in payout status.

For married couples, the 2016 income level for home care (community) Medicaid is $1,209 per month and $21,750 in resources. To prevent spousal impoverishment when a spouse enters a nursing home for long term care, in 2016 the community spouse can keep a higher level than the home care allowance, ranging from $74,820 to $119,220 in resources plus $2,980.50 per month in income (MMMNA).

The Medicaid Spend-Down program is available for those who do not meet the income requirements for Medicaid and are aged, blind, or disabled, under 21, pregnant or ADC (Aid to Dependent Children) related. If your income exceeds the limits, you may qualify for the Medicaid home-health-care program if you incur or pay medical charges equal to your excess countable income or use a Pooled Income Trust for the excess (surplus) income.

There is no penalty period for the transfer of assets when applying for community Medicaid (home-care services), some adult day-care programs, prescription-drug coverage, medical care, and other Medicaid benefits and programs. By contrast, there are strict penalties imposed by Medicaid for the transfer of assets if long term nursing home care is needed. Under the nursing home transfer of resources and income rules, the Medicaid office will look at transfers made up to five years back and will penalize you for these transfers as of the date of the nursing home application going forward.

It is crucial that you do not transfer any of your assets before consulting an elder law attorney who is well versed in the fields of long term care, benefits and entitlements, preservation and transfer of assets, Medicaid, Medicare, and disability planning. The Deficit Reduction Act of 2005 imposed harsh penalties for transfers and extreme caution must be taken before any transfers are made.

In order to plan for your future or if you have any questions contact Fern J. Finkel or Julie Stoil Fernandez at Finkel & Fernandez, LLP
16 Court Street, Suite 1007, Brooklyn, New York 11241, 347-296-8200 (telephone), 718-965-3185 (fax), ffinkel@ffelderlaw.com, jstoilfernandez@ffelderlaw.com.