Pierro, Connor & Strauss, LLC assists seniors with chronic care health needs and individuals with disabilities to qualify and apply for Medicaid Benefits. Our Medicaid lawyers provide planning for people who want to protect and preserve their assets like their home and their retirement savings in order to get long-term care benefits in the home or nursing home — all without spending down to impoverishment.

Medicaid is a needs-based program that follows strict income and asset guidelines, and the levels for qualification change from year to year. We can meet with clients, explain the current rules and assist with the development of a plan which would enable the client or a loved one to apply for Medicaid benefits, either at home in the community or in a nursing home. Refer to our 2021 Medicaid Guide for detailed information.

Have You Considered the Potential Long-Term Care Needs for You or Your Spouse?

Research shows that 50% of all people over 65 require long-term care at some point. While most people prefer to stay in their home to receive care rather than enter a nursing home facility, the enormous cost of long-term care combined with the lack of adequate services available means that for many families, a nursing facility becomes the only option.

Medicaid Lawyer Team
Louis W. Pierro
Aaron E. Connor
Peter J. Strauss
Frank E. Hemming III

Call us today for a consultation

In New York State, the annual cost of long-term care has reached $135,000 to $200,000 – a number that has risen every year for the past two decades! Few could afford to pay $300 to $525 per day for care, let alone the even heftier cost for round-the-clock care at home.

What many people fail to realize is that their health insurance and Medicare will not cover the cost of long-term care — whether at home, in assisted living, or in a nursing facility – so the burden falls to the individual. However, there are a number of excellent planning options for long-term care available despite Medicaid’s rigid requirements.

Medicaid is considered a “last resort” safety net and strict financial requirements (along with other eligibility criteria) must be met in order to qualify. The good news is that even if you believe that your financial situation does not meet the criteria, the Medicaid lawyers at Pierro, Connor & Strauss can implement a variety of planning strategies to help you preserve your assets and still get the care you need.

What Is Medicaid?

Medicaid is a government benefits program that provides coverage for medical expenses and long-term care to those with medical needs and who meet certain financial criteria.

The average cost of a private room in a nursing home in New York is $12,927 per month. That means families are spending more than $155,000 to ensure their loved one’s care. Even staying in one’s home can be costly. Albany is one of the most expensive places in the state to receive in-home health aides, with an average hourly rate between $27-$29. Given these expenses, more than 6 million New York residents find it necessary to receive assistance from federal and state sources.

A considerable amount of planning is needed prior to filing for Medicaid. Planning is needed to ensure the protection of life savings and assets without having to spend down to almost nothing. Contact Pierro, Connor & Strauss, LLC to schedule a free consultation with a Medicaid lawyer who can help you pay the exorbitant cost of long-term care while also protecting your assets.

New York Considerations: Changes to NYS Medicaid Effective May 16, 2022 and more coming potentially in January 2023.

Medicaid is a federal program administered by the states, so local laws can affect eligibility. Medicaid rules change all the time, creating stress and uncertainty for those who require long-term care and their families. The attorneys at Pierro, Connor & Strauss LLC provide compassionate service and direct answers to help clients navigate these changes. There are often strategic actions that can help a person qualify for assistance.

Recent changes to New York State Medicaid rules have made it absolutely essential that seniors and their families start planning for long-term care early, BEFORE the immediate need for that care arises. New Medicaid rules that have been passed recently, include:

  • As of May 16, 2022, in-home care must be prescribed by an independent physician approved by the New York State Department of Health, rather than the patient’s medical provider. A new assessment tool will be used to determine how an applicant’s needs might be met through telehealth, family, and social supports.
  • Expanded Lookback for Community-Based Long-Term Care: Prior to October 1, 2020, there was no lookback for “community Medicaid” with long-term care provided by aides in one’s home. A lookback on transfers of certain financial assets to determine Medicaid eligibility will likely commence sometime after January 2023, with the lookback period being expanded to ultimately cover 30 months. There is still time to start planning before this potentially catastrophic change goes into full effect.
  • Medical Criteria: An applicant currently needs assistance at least two “Activities of Daily Living” (ADLs) to be eligible for Medicaid benefits at home. In 2023, the law is likely to change to mandate assistance with at least three ADLS. 

Long-Term Planning With the Assistance of a New York Medicaid Lawyer

A Medicaid lawyer can assist in planning for care. Most commonly, we can help by establishing a Medicaid Asset Protection Trust, which can preserve assets — such as the family home, bank accounts, stocks, bonds, annuities, life insurance, business interests, or other real estate — for a spouse, children, or other beneficiaries. A properly drafted trust also provides tax benefits, while avoiding the need for the family to eliminate assets or go through probate court, which can be costly and time-consuming.

In the past, families facing a senior crisis could rely on assistance from hospital social workers, discharge planning nurses, and home care assistants. These positions have been virtually eliminated due to cost-cutting measures in the health care system. Today, families can enlist the help of a Life Care Coordinator, who knows the health care system inside-out, and a New York Medicaid lawyer, who will devise the legal and financial strategies that help you pay for long-term care.

Who Qualifies for Medicaid in New York?

To qualify for Medicaid, an individual must:

  • Be a permanent resident of New York State, where you will be receiving Medicaid services.
  • Be 65 years of age or older and/or have a disability, such as blindness.
  • Meet the requirements for medical necessity: Medicaid recipients have medical conditions or require assistance for daily tasks and activities. The medical criteria that needs to be met to qualify for Medicaid may be different depending on whether you are seeking benefits for home care or care in a nursing home facility. Pierro, Connor & Strauss can review your medical information to determine your individual medical eligibility requirements.
  • Meet maximum income & assets eligibility requirements: In 2022, an individual applying for Medicaid who is 65+ years old must not exceed $954 in monthly income. If you live with a spouse, the monthly income limit is $1,387. The amount of resources you can retain and still qualify for Medicaid is $16,800. These numbers may change depending on a variety of variables and the income and asset limits change annually. Remember that Pierro, Connor & Strauss can advise you of effective Medicaid planning strategies that can protect your assets and help you meet the eligibility requirements for receiving benefits.

Why Medicaid Planning Is So Important

Medicaid eligibility is complex, with ever-changing rules that vary from program to program.

Medicaid planning can:

  • Make sure you are able to cover the costs of health care without spending down all of your assets.
  • Help you structure financial resources and preserve assets for children and grandchildren in a secure trust so you can leave a legacy to your heirs.
  • Protect against Medicaid Estate recovery.
  • Help a non-applicant spouse live independently while a partner is receiving care.
  • Reduce the caregiving burden on adult children when both partners require long-term care.
  • Avoid application errors and ensure the best odds of first-time approval.

Medicaid Frequently Asked Questions

Medicaid covers a broad spectrum of healthcare services, including the cost of doctor’s visits, dental appointments, and hospital expenses. Medicaid also covers long-term care costs, whether at home, in assisted living (in certain facilities), or at a nursing home. Prescription drugs are not directly covered, but Medicaid may pay the premium for the Medicare prescription drug plan for eligible recipients.

Unfortunately, Medicare will not cover the cost of long-term care at home or in a skilled nursing facility. Neither will private health insurance. Medicaid is the only government benefit that will cover these costs.

With limited exceptions, Medicaid in NYS does not cover assisted living. Medicaid will pay for care at home or at a skilled nursing facility, such as a hospital, rehabilitation center, or nursing home, or for caregivers to provide assistance in one’s own home. New York does have an ‘Assisted Living Program,’ where Medicaid covers the costs of care, but most assisted living facilities do not participate in the program.

The income and asset limits change annually. Please see our current Medicaid qualification handout.

There are special rules which can help protect the family home for many clients. Pierro, Connor & Strauss can advise on the best techniques to protect this important asset.

The rules surrounding how to qualify for Medicaid are complex and vary depending on the applicant’s assets. Under the current Medicaid rules, we can often assist families to preserve a large percentage of their assets, even when they have not previously completed any planning.

Ideally, the best time to do planning is at least 5 years before the potential Medicaid applicant becomes ill and requires assistance. But, there are still many techniques that help to protect assets, even if the client is unable to wait five years from the date of planning to a Medicaid application.

A “penalty period” is a period of time an individual would be ineligible for Medicaid because he or she has made uncompensated gifts or transfers in the five-year period prior to a Medicaid application.

No. Currently, a “penalty period” is only assessed against gifts or transfers when an individual applies for a “Chronic Care” Medicaid. This is Medicaid if the applicant is in a hospital, rehabilitation center, or skilled nursing center (nursing home). A new 30 month look-back period has been approved for “Community” Medicaid applicants (care at home). IT is believed that this new look-back period will likely go into effect no earlier than April 1, 2022.

New York Medicaid Lawyers Serving NYC, Albany, and Beyond

 

If you or a family member require skilled nursing services, either at your home or in a skilled nursing facility in the New York City / Albany region, contact Pierro, Connor & Strauss, LLC for a consultation with a NY elder care planning lawyer to determine what planning is necessary in order to qualify for Medicaid services.

Life Happens…..Are You Prepared?

Contact us today for a FREE consultation and we’ll be happy to help take the worry out of tomorrow so you can live today.

Call Us