Many seniors prefer to live independently at home for as long as possible, receiving assistance as needed. The Medicaid government program not only pays for nursing home residency, but also for in-home care provided by a licensed agency and in some cases by individuals the family chooses. At Pierro, Connor, & Strauss, LLC, we help our clients protect and preserve their assets so that they can qualify for Medicaid and afford the exorbitant cost of long-term care. By doing so, we give our clients the ability to live in the comfort of home with dignity and independence.

What Does Medicaid Home Care Cover?

  • Certified Home Health Agency Services – Individuals with serious medical conditions can access a certified home health aide or registered nurse who can perform skilled medical care in the home after a hospital stay or for long-term care reasons. A visiting nurse may assist with speech, physical or occupational therapy, nutritional services, and medical equipment use — on a part-time basis.
  • Personal Care or Home Attendant Services – Medicaid personal care home attendants can aid with “Level 1” tasks such as home cleaning, meal preparation, grocery shopping, and laundry — limited to eight hours per week. Home attendants also assist with “Level 2” personal need tasks like bathing, toileting, dressing, grooming, taking medication, and walking.
  • Consumer-Directed Personal Assistance – A family member (other than a spouse), friend, or guardian living outside the home may be trained and paid to perform care duties typically supplied by an agency.

General Eligibility Requirements for Medicaid Home Care in New York

Income: In 2024, a single person applying for Medicaid home care must not have more than $1,752 in monthly income. Couples may have up to $2,371/month. Surplus income must be contributed to the cost of care unless placed in a pooled income trust.

Resources: Medicaid, unlike Medicare, is a means-based program, which means that only persons of limited means are eligible (“countable” assets of only $31,175 for an individual ; for a couple the limit is $42,312. Please refer to the Medicaid eligibility page for a full understanding of the assets that are counted or exempt.)

The care available to New York’s most vulnerable seniors and people with disabilities will soon face draconian changes, with new rules announced by the Department of Health that will limit eligibility and access for new Medicaid applicants.

The rule changes will present significant new challenges to seniors and people with disabilities, transforming New York’s Medicaid home care benefits from the most generous in the nation to a more restrictive program.

Instead of getting needed care in the home, residents with chronic illness who have failed to plan will be ineligible to receive benefits and will need to pay out-of-pocket for home care during a penalty period, thus being forced to spend down life savings.

Adverse state rules include:

  • Independent Assessor (NYIA) has replaced counties and Managed Long-Term Care programs (MLTC) to determine your Medicaid eligibility, i.e. Do you get care benefits? And if you do, how many hours?
  • No role for your physician. An ‘Independent Physician Panel’ reviews applications.
  • Additional Medicaid are conducted by “Independent Review Panel” if elder or disabled person needs more than 12 hours/day of home care
  • Reduced appeal rights
  • More ways the government can curtail or eliminate your home care benefits

New “Lookback” Expected To Be Enforced in 2025 based on latest information from New York State:

Medicaid, unlike Medicare, is a means-based program, which means that only persons of limited means are eligible (“countable” assets of only $31,175). Currently, an applicant can give away assets and then apply for Medicaid community-based care the following month, without penalty.

One of the most prohibitive changes is to financial eligibility rules for Medicaid applicants, by imposing a ‘lookback’ for asset transfers phased in for a total of 30 months. This rule took effect in October 2020 but will not be implemented until some point in 2025, dependent on NYS guidance. Applicants who transferred assets during this new lookback period will face a period of ineligibility when Medicaid will not be available to them.

As a result, there is a period of time when Medicaid planning can be completed, such as gifts to family members or transfers into a Medicaid Asset Protection Trust. These gifts won’t case a waiting period, but only if the application for Medicaid is filed prior to the new lookback implementation date. Once qualified, applicants can begin services without application of the new penalty of other stringent rules.

Fortunately, existing exceptions to the transfer of asset penalty rules, such as gifts to a spouse or a person who is disabled or blind, have not been repealed.

Do You Need a Medicaid Home Care Lawyer?

You can benefit from the assistance of an elder care planning lawyer if:

  • You would like to receive care, live at home, and have some money left to leave as inheritance.

Home health care is an attractive alternative to institutionalized elder care. However, it doesn’t come cheap. People over age 65 looking to stay in their homes can expect to pay upwards of $12,000 per month, and much more in metropolitan areas. New Yorkers who have a chronic illness and are no longer 100% self-sufficient face a difficult choice: move to a Medicaid-funded skilled nursing facility or spend their life savings on home care assistants. Without financial assistance from Medicaid, most people would be unable to afford to remain in their homes.

  • You are concerned about qualifying for Medicaid services and potential consequences.

The Medicaid application process can be confusing. Errors and misunderstandings can lead to undesirable consequences – like denial of benefits, a lien placed on the home, or forced liquidation of assets. Pierro, Connor, & Strauss, LLC, wants you to retain your independence and lifesavings while receiving access to the care you need to live comfortably. Call for a free consultation to explore your options for staying in your home as long as possible.

  • You are confused about recent changes to Medicaid benefits for home care in New York.

New York’s Medicaid program changes from one year to the next. Eligibility for Medicaid in-home care service requires the beneficiary to be generally homebound and require skilled care. You must have assets and monthly income below certain guidelines. Recent laws have made it more difficult for family and friends to obtain compensation to care for a loved one in the comfort of home. As referenced above, new limitations to home aide service coverage are going into effect, and individuals must show evidence they require assistance for multiple activities of daily living in order to receive help with basic needs care. Recently approved lookback periods may disqualify applicants due to gift transfers to trusts or family members. Fortunately, many of these changes occur in a phased manner, and there is still time to consult with an estate planning lawyer for at-home elder care without spending down all your assets.

Learn More About Planning for Medicaid In-Home Care

For over 40 years, Pierro, Connor, & Strauss, LLC has provided trusted elder care counsel to New York residents in Albany, Greene, New York City, Rensselaer, Saratoga, and Schenectady. Boasting over 280 years of combined experience, our attorneys are rated by Super Lawyers and AV Preeminent Lawyers. Call any time to schedule a free consultation with a Medicaid lawyer. We strive to take the worry out of tomorrow, so you can live today. Schedule a free consultation by calling (866) 951-PLAN (7526) or email us at [email protected].