NEW YORK MEDICAID ELIGIBILITY
PAYING FOR HEALTH CARE
Medicare is the primary payer of health care with supplemental insurance filling the gaps in Medicare coverage. However, Medicare and supplemental insurance do not cover long term (custodial) care.
Custodial care expenses are covered by private payments, long term health care insurance or the Medicaid program- if one meets the Medicaid qualification requirements.
MEDICAID IN NY IN 2017
Generally, the rules in New York are as follows. In order to be eligible for Medicaid in 2017, an individual may possess no more than $14,850.00 in countable resources. Where countable (non-exempt) assets exceed the allowable Medicaid limit, with proper legal guidance, a portion may be transferred, prior to applying for Medicaid, instead of being spent down. An uncompensated transfer of resources (gifting) would create a period of ineligibility for Institutional Medicaid (i.e., care in a nursing facility), unless the gift was made to a spouse (inter-spousal gifts do not cause a penalty period). For every $12,198.00 gifted in Westchester, Putnam, Orange, Rockland, Sullivan, Ulster, & Dutchess Counties ($12,157.00 in New York City; $12,811.00 on Long Island) to a person other than a spouse, a one month penalty is imposed by Medicaid- rendering one ineligible for Medicaid until the penalty period has expired.
If the Medicaid application is submitted properly, the maximum period that benefits will be denied is five years. Transfers made more than 5 years before the date of the Medicaid application are ignored by Medicaid.
The penalty period begins to run when all four of the following factors exist:
1) the applicant is residing in a nursing or rehabilitation facility;
2) an institutional Medicaid application is submitted;
3) the applicant has countable assets below $14,850.00; and
4) the applicant’s income is insufficient to pay their medical expenses.
An applicant would need a source of private pay if a penalty period is imposed.
Note that the Medicaid transfer penalty rules, imposing a period of ineligibility for Medicaid, apply only in relation to Institutional care in New York; no penalty period is imposed for Community based Medicaid (“home care”) regardless of gifting. That is, an individual may gift assets in one month and qualify for home care on the first of the very next month. Home care is limited though- frequently, insufficient hours of care are provided- but families can supplement the care by privately paying for nurses or aides.