Medicaid Eligibility

Our goal is to help clients get the care they need, without depleting life savings.

The rules governing Medicaid are complex and frequently change, requiring great care in the planning and application for benefits. The lawyers at Pierro, Connor & Strauss have helped thousands of clients navigate the daunting Medicaid planning and filing process. If you or a loved one needs long-term care in the home, a skilled nursing facility or in some instances assisted living, there are excellent planning options available. Under new Medicaid eligibility rules; however, waiting to plan is NOT one of those options.

With proper legal planning, Medicaid-eligible residents can preserve assets and afford the high cost of long-term health care in the environment of their choosing.

Federal Medicaid Eligibility

To be eligible for the Medicaid program, the federal government requires individuals to be:

Citizens of the United States or lawful permanent residents.
Residents of the state in which they are receiving Medicaid
In all states: individuals can qualify based on income, disability, family status, household size and additional factors. Eligibility rules differ between states.
According to the website healthcare.gov, for states that have expanded Medicaid coverage, “you can qualify based on your income alone. If your household income is below 133% of the federal poverty level, you qualify. (Because of the way this is calculated, it turns out to be 138% of the federal poverty level. A few states use a different income limit.)

Functional Need

To live in a care facility or receive at-home assistance, individuals must require assistance with at least two Activities of Daily Living — bathing, dressing, toileting, transferring, eating, and walking – due to a physical impairment or a combined physical/cognitive impairment.

Financial Eligibility

Income and Resource limits vary by State and are typically very low. Fortunately, New York rules are favorable with high levels that increased dramatically in 2023.

New York Medicaid Eligibility

States are granted the flexibility to administer the program as they see fit, as long as it is within the scope of the federal guidelines.

New York Medicaid eligibility rules cover:

Single Person Eligibility – In 2023, a single person has a resource limit of $30,182. Investments, cash in CDs, cash in life insurance policies, and secondary homes may need to be sold in order to qualify. Nursing home residents are only entitled to keep $50 of monthly income. Home care recipients can keep $1,697 of monthly income.

Married Couple Eligibility – The non-applicant spouse can keep an allowance of $74,820 to $148,620 of the couple’s combined life savings. The non-applicant spouse is also entitled to keep $3,715.50 of the couple’s combined income. If the non-applicant has personal income above that amount, the Medicaid Agency will request a contribution of 25% of all income above $3,715.50.

Do I have to “Spend Down” to Qualify? – Generally, the answer is no, with proper planning. The Elder Care lawyers at Pierro, Connor & Strauss can explain which assets are factored into your Medicaid application and advise on exemptions and options to transfer certain assets that may or may not result in a penalty, while preserving as much as possible.

When applying for Medicaid in a nursing home, the Medicaid Agency can look back at all bank statements and financial transactions within five years.

However, there are many exceptions, which can be important for preserving life savings in a time of transition or crisis. Creating an irrevocable trust is one way to retain some assets including property and certain financial holdings.

The earlier one plans with the help of an elder care planning lawyer, the better, as there is a penalty period of ineligibility for Medicaid coverage after a transfer is enacted. Even in crisis situations with immediate care needs, though, our attorneys can often help clients preserve a portion of their life-savings.

An Independent Assessor and Independent Physician panel now review applications to determine the number of hours of care – instead of your own physician. And, an Independent Review is required if the elder or disabled person needs more than 12 hours/day of care.

While we await final guidance from the New York State Department of Health, New York will be phasing in a new 30-month lookback window expected in April 2024 with regard to asset transfers for the Community Medicaid program, which provides long-term home and community-based services. Seniors will want to start planning now to take advantage of favorable rules while they exist, and to avoid costly penalties or rejection of an application.

Individuals are required to meet at least two medical criteria for assistance with activities for daily living.

Seniors looking to retain their assets while also receiving assistance to pay the exorbitant cost of long-term care are invited to contact a Medicaid planning lawyer at Pierro, Connor, & Strauss, LLC for a free consultation. We proudly serve the New York City region, Long Island, Westchester, Hudson, Lake Placid and the Capital Region including Albany, Schenectady, Rensselaer, Saratoga, Columbia, Greene Counties and beyond with exceptional elder care planning services.

Medicaid Eligibility

Our goal is to help clients get the care they need, without depleting life savings.

Federal Medicaid Eligibility

Functional Need

Financial Eligibility

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New York Medicaid Eligibility

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