New York Medicaid Planning Lawyer | NY Medicaid Planning & Application

Medicaid Planning and Eligibility in New York

Medicaid planning is an advanced method of estate planning that can help you become eligible for Medicaid assistance. In the long run, Medicaid can help you save money even if your income and assets may be too high to qualify. Medicaid planning in New York is an arduous process as the application process can be time consuming and regulations can change rapidly. Due to Medicaid rules, it is important to do Medicaid planning early, at least 5 years before needing long-term care. No matter if you are planning early or not, consulting an experienced and qualified Medicaid planning attorney in NYC who specializes in elder law is highly recommended.

What is Medicaid?

Medicaid is a state-administered health care coverage that is funded by both the state and the federal government. Each state runs its own system and therefore coverage as well as eligibility is different across the country. Medicaid works to provide for people with little to no income and eligibility is situational. Factors such as pregnancy, age, disabilities, and more are all taken into account. While they cover around ⅕ of Americans, their spending is primarily focused on the elderly, with 65+ year-olds receiving the most spending. New York Medicaid gives its participants access to a number of healthcare providers with no cost besides copayments.

New York Medicaid can be divided into two programs: New York State Nursing Home Medicaid and New York State Home and Community Based Medicaid, under which Regular Medicaid and Medicaid for the Aged/Blind/Disabled falls. These two programs provide different services, have different eligibility requirements, and have different lookback periods. To better understand each program and the differences between them, please carefully review this page. A Medicaid planning lawyer will help to alleviate your confusion and ensure that you acquire the Medicaid coverage in NY that you require. To schedule a medicaid planning and medicaid asset protection consultation, call the Law Office of Inna Fershteyn at (718) 333-2394 or use the ‘SCHEDULE CONSULTATION’ button below.

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Medicaid Eligibility

To be eligible for New York Medicaid, you have to be a resident of New York State, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:

Pregnant, or
Be responsible for a child 18 years of age or younger, or
Blind, or
Have a disability or a family member in your household with a disability, or
Be 65 years of age or older.

What is Medicaid Planning?

Medicaid planning is any assistance provided to a potential Medicaid applicant in advance of and in preparation for their Medicaid application. It can be as simple as collecting and preparing needed documents for the application or as complicated as structuring your finances. Medicaid planning becomes more complicated when your monthly income or assets exceed the eligibility requirements. In order to protect your assets and become eligible to obtain Medicaid, Medicaid planning with an attorney in New York is needed. In addition, due to Medicaid rules allowing Medicaid to look into your assets years before you apply, it’s important to do Medicaid planning early. The consequences of being investigated and denied by Medicaid can be severe as it can have negative impacts on the financial security and health of the individuals applying for help. Therefore it is best to consult with an experienced and qualified elder law attorney. At the Law Office of Inna Fershteyn we will help you thoroughly structure your financial resources, such as relocating assets, and prepare any documentation, such as trusts and estates to ensure your highest chances of being accepted to the Medicaid program.

New York State Community Medicaid Guidelines (Home Care Aid Medicaid)

2023 New York Community Based Medicaid Eligibility Requirements

Income Eligibility: For a single individual, aged 65 years or older, monthly income must be less than $1,677. For two people, aged 65 or older, monthly income must be less than $2,268.
Asset Requirements: A single applicant, aged 65 or older, can have less than $30,180 in liquid (countable) assets to be eligible for New York Community (home care aid) Medicaid. A couple, with both applicants aged 65 or older, can have less than $40, 821 in liquid (countable) assets to be eligible for New York Community (home care aid) Medicaid.
- First, determine if your asset is a countable asset or an exempt asset. Homes, home furnishings, and vehicles are considered exempt.
- Second, all the assets of a married couple, regardless of whose name the asset is in, are considered jointly owned and are counted towards the asset limit.

BREAKING NEWS: New York Community Medicaid Changes for 2024

The laws and procedures surrounding Medicaid are constantly changing. If you're an individual who is currently receiving benefits or is in the process of applying for Medicaid, it's important to stay updated on these changes to make sure you don't jeopardize losing your benefits. Here are Medicaid Changes Going Into Effect In 2024.

New York Community Medicaid will be implementing a Look-Back Period. The Look-Back period will be 30 months instead of the 60 months required for Long-Term Care Medicaid. The earliest New York State plans to implement this change is March 31, 2024.

How to Apply for Medicaid in New York?

You can apply for Medicaid in NY through:

- NY State of Health: The Official Health Plan Marketplace
- A Managed Care Organization (MCO)
- The Medicaid Helpline- (800) 541-2831
- Your Local Department of Social Services Office

Medicaid eligibility is determined using Modified Adjusted Gross Income (MAGI) rules.

Those part of MAGI eligibility groups, such as adults aged 19-64 who do not qualify for Medicare, can apply through the NY State of Health.

Those part of non-MAGI eligibility groups, such as adults over the age of 65, blind, or disabled persons who do not meet MAGI eligibility criteria, can apply through their Local Department of Social Services or a Facilitated Enroller for the Aged, Blind, and Disabled.

In order to qualify for New York Community Medicaid (Home Care Aid), the following documents are needed:

New York Medicaid: Commonly Asked Questions

What is the income eligibility limit for New York Home Care Aid Medicaid in 2023?

Individual income level limits for 2023 are $1,677 monthly/$20,121 yearly. Income level limits for couples are $2,268 monthly/$27,214 yearly.

How does New York Medicaid verify income?

New York State’s Medicaid Program has access to an applicant’s IRS and Social Security information. They can tell if the applicant underreported their income and will open an investigation if necessary.

What assets are exempt from Medicaid lien by New York Medicaid?

Assets exempt from Medicaid in New York include an applicant’s primary residence, household items and appliances, personal effects, one motor vehicle that must be used for transport, a burial plot, burial fund up to $1,500, term life insurance, and, in some cases, 401(k)/IRA retirement accounts. A Medicaid planning attorney will help to determine exactly which of your assets will be exempt from Medicaid eligibility considerations.

What health services are covered by NY Community Medicaid?

Medicaid covers a variety of services depending on eligibility criteria, including:

- All regular medical checkups and required follow-up care,
- Immunization,
- Doctor and clinic visits,
- Medicine,
- Medical supplies, equipment, and appliances (e.g. wheelchair),
- Emergency care,
- Hospitalizations,
- Transportation to and from medical appointments,
- Transportation to and from hospitals,
- Nursing home care,
- Dental care.

While this is certainly not an exhaustive list, it should give you some idea of the medical services that Medicaid covers. A Medicaid planning attorney will help you gain a better understanding of your eligibility status and what covered services it entails.

How can I protect my house from Medicaid lien in New York?

You do not need to give away or sell your home if it is your primary residence to qualify for Medicaid in NY as it is considered exempt property. If you have a primary residence that is appraised for less than $955,000 you can qualify for community Medicaid, which in turn will allow you to receive home care aid hours. However, passing your house to beneficiaries after death can be tricky as Medicaid can ask for Medicaid reimbursement when a valuable asset is transferred through probate or administration. Thus, to protect your house from Medicaid liens and to make sure your beneficiary receives all assets outright and does not need to be stuck in probate or administration indefinitely, a Medicaid Asset Protection trust should be created by a reputable New York Asset protection and Medicaid planning lawyer.

Can I own a home and be on Medicaid in New York?

To qualify for Medicaid in New York, one must be below the state’s asset limit which is currently $30,182 for individual applicants and $40,821 for couples. An applicant's home is exempt from Medicaid eligibility considerations so long as it is their primary residence or, in the event they need nursing home care, they intend to return to it upon recovery. In these cases, the home equity interest, or the current value of the home minus any outstanding mortgage, must not exceed $955,000 for a Community Medicaid applicant and $1,033,000 for applicants seeking nursing home care (Nursing Home Medicaid). It must be noted that secondary or vacation homes are not exempt from Medicaid considerations.

If my spouse is going to a nursing home, can he transfer our home to me and qualify for Medicaid?

No, it is considered a marital asset. You will have to create an Irrevocable Trust and transfer your house into such a trust 5 years ahead of any Medicaid application for the transfer to be accepted by the nursing home. It is also in your spouse’s best interest to gift other financial assets that may help him or her qualify for Medicaid.

How long will it take for my NY Medicaid application to be accepted or denied?

In most cases, a decision will be made and provided to you within 45 days from the date you submit your application. However, if you are pregnant, applying on behalf of your children, or have a disability, the amount of time may vary.

What happens if my income exceeds the limit for NY Medicaid?

There are several options available to you if your income exceeds the limit for Medicaid:

- If you are applying for long-term Medicaid coverage and your spouse is not, you can transfer some or all of your monthly income to them as a community spouse via the Minimum Monthly Maintenance Needs Allowance (MMMNA), which they can use to cover living expenses.
- Applicants over the limit and applying for long-term Medicaid coverage can use the Medically Needy Pathway to subtract certain medical expenses from their monthly income. If after this deduction the applicant is below the Medically Needy Income Limit, which varies by state, they can qualify for long-term Medicaid coverage.
- Applicants can place excess income into a Qualified Income Trust.
- Applicants can explore a variety of revocable and irrevocable trusts that will allow them to relinquish official ownership of certain assets. This option must be done well in advance of any Medicaid application.

All these options should be explored with a Medicaid planning attorney to ensure that you qualify for the Medicaid coverage you need and your assets are protected.

Should I plan in advance?

Yes, it is recommended to plan well ahead of time. Unexpected circumstances may arise at any time and may prolong or complicate the planning process. Even if you or your family individual are not currently in need of Medicaid, it is better to be prepared instead of having to pay large out-of-pocket fees unexpectedly. It is recommended that you enlist the services of a skilled Medicaid planning attorney to handle your Medicaid planning.

How can my family and I be protected from long-term care expenses?

Medicaid planning involves creating a strategy to conveniently preserve your assets. Different clients may have differing assets and financial resources. Common tools used to protect assets and increase the likelihood of eligibility for Medicaid include: creating irrevocable trusts, life estates, and converting assets to non-countable assets.

Will Medicaid Pay for Nursing Home Care?

Yes, one of the benefits of receiving Medicaid is that it will cover the cost of nursing home care. If you are eligible and are planning on being admitted to a nursing home, Medicaid pays for the full care. However, it is essential to follow all the guidelines when receiving Medicaid to ensure that you avoid the risk of having it taken away, which will leave you in significant debt.

How much money can you have in the bank to qualify for Medicaid in New York?

Those applying for long-term Medicaid coverage can generally have up to $2,000 in their bank account(s). Every dollar after that will be counted toward Medicaid eligibility considerations. Those without further exemptions might find it difficult to qualify for all the services they need, though consulting with a Medicaid planning attorney will assure the best possible outcome for you and your family.

Can you own a car on Medicaid in New York?

A Medicaid applicant can own a car and not have it count toward their Medicaid eligibility under certain exemptions:

1. They need the car for work.
2. They need the car for transportation to medical appointments.
3. They need their car for transportation in a rural area.
4. Their car has been modified to accommodate a disabled person.

Any car a Medicaid applicant owns beyond the one qualified under one or more of these exemptions and is not otherwise their primary mode of transportation cannot exceed a value of $4,500; otherwise, it is considered part of their estate and will count toward liquid asset limits.

Will my Medicaid renew automatically?

With the end of the COVID-19 Public Health Emergency, the pause on yearly Medicaid renewal was lifted as of April 1st, 2023. Your Medicaid application will need to be renewed yearly and all pertinent information updated as necessary.

How many years does Medicaid look back in New York?

New York State’s Medicaid lookback law requires a lookback period of 60 months for those seeking long-term care Medicaid services. All gifts and asset transfers an applicant makes in the lookback period before their application date are subject to review and Medicaid eligibility requirements.

New York Long-Term Care Medicaid Requirements

What is Medicaid Long-Term Care?

Long-term care enables patients, usually either disabled or elderly, to get assistance with the many “activities of daily living”. This includes chores such as cooking, cleaning, and getting ready for appointments as well as medical care. The goal of long-term care is to allow patients access to their desired lifestyle when they may be unable to do so themselves. New York City long-term care providers provide alternatives to nursing homes for patients who wish to remain in the comfort of their homes by providing personalized care. With the four options available, it’s important to plan for the possibility of long-term care.

New York Medicaid Long-Term Care Eligibility

Income Eligibility: For a single individual, aged 65 years or older, monthly income must be less than $1,677. For two people, aged 65 or older, monthly income must be less than $2,268.
Asset Requirements: A single applicant, aged 65 or older, can have less than $30,180 in liquid (countable) assets to be eligible for New York Community (home care aid) Medicaid. A couple, with both applicants aged 65 or older, can have less than $40, 821 in liquid (countable) assets to be eligible for New York Community (home care aid) Medicaid.
- First, determine if your asset is a countable asset or an exempt asset. Homes, home furnishings, and vehicles are considered exempt.
- Second, all the assets of a married couple, regardless of whose name the asset is in, are considered jointly owned and are counted towards the asset limit.

Look-Back Period: The look-back period for an applicant applying for long-term care Medicaid in New York is 60 months. All gifts and asset transfer in the 60 months prior to the date of application are subject to review and Medicaid eligibility requirements.

Types of Long-Term Care Facilities in New York

Nursing Homes- Nursing homes are one of the most popular types of long-term care. They provide 24-hour nursing care to individuals who are chronically ill or injured, have health care needs and personal needs, and are unable to function independently. However, a nursing home goes beyond medical care. It’s a place where patients can go on with their lives – and even engage in many activities they may have never taken part in before – while under the secure and capable watch of a team of trained caregivers.
Residential Homes for the Aged- These facilities only provide residents with room and board and some assistance with personal needs such as eating and grooming. However, homes for the aged are neither staffed nor licensed to provide nursing care. Instead, they are designed to provide a place for people who are able to care for themselves with little or no help. Someone who lives in one of these facilities has to be physically and mentally capable of finding their way to safety in the event of an emergency without assistance from someone else.
Assisted Care Living Facilities- Assisted living is a middle ground between homes for the aged and nursing homes. Assisted living is a long-term care option for seniors who need more assistance than is available in a retirement home, but who do not require the intensive medical and nursing care provided by a nursing home. Many seniors relocate to an assisted care living facility after rehabilitating in a nursing home or hospital, while others come directly from their homes. These facilities provide the same services as a home for the aged and assistance with medications. Some facilities are even staffed and licensed to provide care for people who have some memory loss or are in the early stages of Alzheimer’s.
Home Health Care- Home health care agencies provide skilled nursing and rehabilitative care, such as physical, occupational and speech therapy. Personal services, like help with bathing and grooming, are also available. If a physician determines that an individual is in need of home health care, services complementing the physician’s recommendation (ex: help with house cleaning or grocery shopping) are also available.

Can I transfer my assets to children just before I go into a nursing home and qualify for Medicaid?

No, transferring your assets right before going into a nursing home will make you ineligible for Medicaid for the next 5 years. This is because long-term care Medicaid has a five-year look-back period, under which individuals who have made or received any asset transfers must wait until five years after the transaction to apply for Medicaid or face a penalty if they apply prior. When transferring your assets, you need to keep in mind that once you make a transfer, it cannot be reversed. A Medicaid planning attorney will better help you understand the Medicaid lookback period and whether you qualify for Medicaid coverage.

What are the best Nursing Home Medicaid Planning Strategies in NY?

Spend Down Assets- One way to reach or stay below the Medicaid asset limit is by spending down assets. There are several ways to do so. For example, home modifications and improvements, such as adding a chair lift, purchasing medical devices that are uncovered by insurance, like wheelchairs, and paying off one’s mortgage or credit card debt. It is important to note that one may not give away assets or sell them for under market value because this may result in a period of Medicaid ineligibility. This is known as the Medicaid look-back rule, which is a period of 5 years before the date of one’s Medicaid application where all past asset transfers are reviewed.
Medicaid Asset Protection Trust- A Medicaid Asset Protection Trust (MAPT) is a particular type of exempt trust used to deposit an individual’s surplus income or assets and therefore preserve their monthly excess income. Medicaid can disregard the deposited money. By depositing the surplus, an individual can lower their total income which is counted by Medicaid, and be within the allowable income limit. Although there is no limit as to the value of the assets that can be placed in this type of trust, MAPTs are a violation of Medicaid’s look-back period. Violating the look back period could result in a penalty period of Medicaid ineligibility, therefore these trusts should only be used well in advance of the need for long-term care Medicaid. If Medicaid is needed in the near future, this strategy is not suggested.
Spousal Transfers & Refusal- According to current Medicaid laws, transfers may occur between spouses without being subject to the five year look-back period. The assets who are under the name of the spouse in need of care should be transferred to the name of the spouse who doesn't require care, typically referred to as the community spouse. With the presence of spousal refusal, the community spouse may refuse to provide necessary support to the spouse in need of care. If this is the case, then the spouse who is in need of care will immediately be provided Medicaid services to ensure that they are provided with all necessary care. Spousal refusal is present in New York, however it may not be present in other states.

What is the Difference between New York Nursing Home Medicaid and Medicare?

Medicaid Planning Case Closed

September 6, 2023

Clients needed Last Will and Testament updated for both husband and wife to make sure that their NY co-op apartment, as well as their bank accounts, will go to their children after their passing. NY Last Will and Testament as well as NY durable power of attorney and NY health care medical proxy was created for both husband and wife and executed in the presence of two witnesses and a notary in accordance with NY EPTL laws.

August 25, 2023

Medicaid asset protection trust was created for an elderly person to make sure that her assets get distributed to her beneficiaries upon her death by passing NY probate proceedings and protecting her estate from creditors if she needs Medicaid and home care during her life.

April 23, 2023

When an elderly individual unexpectedly went to rehab and needed emergency home care aid to prevent staying at a nursing home, the law office of Inna Fershteyn came to the rescue. We immediately prepared an irrevocable trust, executing it with a crucial power of attorney. The client’s bank account, totalling over $400,000, and house was transferred into the trust. Additionally, the attorney prepared a health care proxy for the client so her daughter could make necessary medical decisions in the event that her mental state deteriorates. Most importantly, an emergency medicaid application was prepared with a pooled income trust for her monthly income. We simultaneously obtained Medicare hours lasting six weeks, so she should come home with peace of mind knowing a home care aid was at her side to help. Lastly, we referred her to a home care agency and successfully obtained a home attendant to take care of her long term.

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“I can't recommend the Law Office of Inna Fershteyn highly enough for estate planning and Medicaid planning for the elderly. We had an emergency situation where an irrevocable trust had to be set up and Medicaid had to be obtained right away and Inna and her team prepared all the documents for my relatives in less than one week. Inna is truly the best elder care lawyer in NY.” -Luis B

“Even after the Medicaid Planning was done, Inna was always available to answer more questions and guide us through additional steps of the process. Our family loved the office and would recommend the Law Office of Inna Fershteyn to anyone who is looking to do their Medicaid or Estate Planning.” – Jessica G.

“Inna was very courteous, understanding and most importantly experienced. I ended up doing a Revocable Living Trust, Will, Living Will and Power of Attorney and later on I came back to Inna to do my Medicaid Planning.” – Natalia B.

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