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Community Medicaid

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By Nancy Burner, Esq.

Nancy Burner, Esq.

Community Medicaid is the program that covers care at home, such as a personal care aide. Chronic Medicaid is the program that covers nursing home care.

The requirements and application process for Community and Chronic Medicaid are very different. An applicant’s marital status implicates a different set of rules. It is important to know the differences and make sure you have the correct Medicaid in effect.

For 2023, an individual applying for Community Medicaid can have no more than $30,182 in assets, excluding the home if the equity is less than $1,033,000. Qualified funds such as IRAs or 401(K)s are exempt, so long as the applicant is taking minimum distributions, and which are counted towards the monthly income allowance. The applicant’s income cannot exceed $1,677 per month — but there are ways to capture the income using a Pooled Income Trust. 

While these limitations may seem daunting, the good news about Community Medicaid is that there currently is no look-back period. No look-back means someone looking to get care at home can transfer assets out of their name and be eligible the following month.

It is important to keep in mind, however, that in April of 2020 New York State passed a law introducing a 30-month look-back period for Community Medicaid. The look-back period was originally set to take effect in October 2020, but was delayed. The New York State Department of Health recently announced that the earliest the 30-month look-back period will be implemented, if ever, is mid to late 2025.

To qualify for Chronic Medicaid in 2023 an individual applicant can have no more than $30,182 in assets, and no more than $50.00 per month in income. There is no pooled trust option to protect excess income, so any income exceeding $50 per month will go towards the cost of the nursing home care. Like Community Medicaid, qualified funds such as IRAs or 401(K)s are exempt if the applicant is required to take minimum distributions. The home is not an exempt resource unless a spouse, disabled or minor child is living there.

Chronic Medicaid has a five-year look-back period. This refers to the period of time that the Department of Social Services will review your financials to determine if you made any transfers. To the extent that the applicant has made transfers or has too many assets in their name to qualify, they will be ineligible for Medicaid. However, there are exempt transfers that the applicant can make which will not render them ineligible:

— A spouse;

— A child under the age of 21;

— A blind or disabled child;

— A sibling who has an “equity interest” in the home and who has lived in the home for at least a year before the Medicaid application is filed; or

— A “caretaker” child who has lived in the parent’s home for at least two years before the Medicaid application is filed.

Due to the complexities of eligibility for Community and Chronic Medicaid, it is imperative to consult with an expert attorney in the field.

Nancy Burner, Esq. is a Partner at Burner Prudenti Law, P.C. focusing her practice areas on Estate Planning and Trusts and Estates. Burner Prudenti Law, P.C. serves clients from New York City to the east end of Long Island with offices located in East Setauket, Westhampton Beach, Manhattan and East Hampton.

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By Nancy Burner, Esq.

Nancy Burner, Esq.

Community Based (homecare) Medicaid is a program that can assist families in paying for the cost of home health aides as well as other programs, supplies and equipment, to help people age in place. Medicaid, unlike Medicare, is a need-based program with certain asset and income requirements.

These separate requirements for Medicaid eligibility must both be met by the applicant. To meet the Community Medicaid asset requirements, an individual is permitted to own a home, have liquid non-retirement assets that do not exceed $15,750.00, retirement savings in any amount, an irrevocable pre-paid funeral account and one car. With respect to income, an applicant may retain a monthly income of $875.00 plus a disregard of $20.00. The recipient must continue to take required monthly minimum distributions from retirement accounts.

Unlike nursing home Medicaid, any excess income can be directed to a Pooled Income Trust for the benefit of the Medicaid applicant and the monies deposited into that trust can be used to pay the household expenses of the Medicaid applicant. These household expenses are not limited to shelter but can include food, luxury items and any non-covered medical expenses.

Until recently, under the New York Medicaid guidelines, there has not been a look-back for Community Medicaid, meaning an applicant for Community Medicaid could transfer an unlimited amount of assets in one month and be eligible the 1st day of the following month. Soon, this will no longer be the case. 

An amendment was made to New York Social Service Law Section 366 subd.5 under the 2020-2021 New York State Budget, wherein a thirty (30) month lookback was instituted for Community Medicaid coverage. The change is set to roll out on October 1, 2020. 

This means that an individual applying for Community Medicaid post-October 2020, will have to submit 30 months of financial disclosure for eligibility purposes. To the extent there are uncompensated transfers or gifting, the applicant will be penalized and not enrolled in Community Medicaid for a specific period. The divisor currently used is $13,407.00, meaning that for every $13,407.00 the applicant transferred for less than fair market compensation, he or she will be penalized for a period of one month.

For example, if it is determined that an application gifted $60,000.00 within the 30-month lookback, the applicant will be ineligible to receive Community Medicaid for approximately 4.5 months, requiring an out of pocket payment for care received for those months. This raises the question of where the money for that care will come from. 

What if you gifted the money without an expectation of receiving it back and without taking into consideration your own care needs? It is still unclear how the penalty period will run, from which date it will be calculated and how applicants will be able to mitigate any transfers they did make during the lookback. 

Similarly, it is not clear if the 30-month lookback will affect those currently enrolled in the Community Medicaid program. The law does not address whether transfers made prior to the change in the law will be exempted from the lookback and whether there will be a post eligibility lookback assessed to those already on the program. 

To remain eligible, a Medicaid recipient must recertify their Medicaid benefits annually. Under the current regulations, only financial documents showing assets and income as of the date of recertification need be provided. However, in light of the new lookback, it is uncertain if the recertification process will now require a 30-month lookback. Likewise, it is unknown whether the local department of social services will discontinue benefits for those recipients who had transferred assets in the last 30 months.

The Community Medicaid program in New York allows our seniors to remain in their home, receiving care. With careful planning this program can still allow many individuals to age in place. The changes to the Medicaid qualification process highlight the need for sound estate planning that includes consideration of asset protection planning.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office. Visit www.burnerlaw.com.

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By Nancy Burner, Esq.

Nancy Burner, Esq.

Concerns about accessing long-term care in the community is something we often discuss with our clients. How will they access the care? Who will pay for it? Is the care reliable? Can I safely and affordably age in place? 

The positive news is that there are many options for care in the community. We are fortunate to live in an area where care is accessible, reliable and affordable. Many of our clients are surprised to learn that Community Medicaid is a way to access care in the community. 

Unlike Chronic Medicaid, which requires a five-year financial look back as a prerequisite for eligibility, Community Medicaid does not have any look back. This means that with some relatively simple planning (in most cases) the financial eligibility requirements can be met with little to no waiting time.

It is important to note there are strict asset and income limitations for applicants for Community Medicaid. An applicant is permitted to have $15,150 in liquid nonretirement assets in his or her name (in New York for 2018). They can have an unlimited amount of qualified (retirement) accounts in their names so long as they are taking the required distribution as set out by the local Medicaid program. 

The primary residence is also an exempt resource, provided the Medicaid recipient remains in the home. It is advisable for all Medicaid recipients to do some estate planning with their home to ensure that it will remain protected should a need arise for care in a facility. Additionally, such planning can ensure that the home is protected from potential estate recovery after the death of the applicant. The applicant is also permitted to have an irrevocable prepaid prearranged funeral account.

With respect to income a single Medicaid applicant is permitted to retain $862 in monthly income. Any income amount over this allowance is considered “excess income.” The good news is that all of the Medicaid applicant’s excess income can be redirected into a pooled income trust, which is a type of special needs trust established and managed by nonprofit organizations for the benefit of disabled beneficiaries. The excess income transferred into a pooled trust can be used to pay the Medicaid applicant’s monthly household and personal expenses.

As you can see, with some relatively straightforward planning most people can qualify for Community Medicaid benefits. Once you have applied and been accepted under the Community Medicaid program, you can access a variety of services that will help you to remain in the community. 

For most of our clients the greatest benefit is the availability of a care provider who can come into their home and provide assistance with activities of daily living such as dressing, bathing, light housekeeping and meal preparation. 

Community Medicaid will also cover the cost of certain approved assisted living facilities and some adult day care programs. The availability and accessibility of care in the community is oftentimes far more available than most of our clients think. 

The community-based Medicaid program is invaluable for many seniors who wish to age at home but are unable to do so without some level of care and certain supplies the cost of which would be otherwise too expensive to sustain on their own. With some careful planning aging in place is certainly a viable option for most clients we meet.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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Community Medicaid covers care at home, such as a home health aide to assist with daily activities.

By Nancy Burner, ESQ.

Nancy Burner, Esq.

For most of us, if a time ever comes when we need assistance, the preferred option would be to remain at home and receive whatever care services we need in our familiar setting surrounded by family. For many, the Community-Based Long-Term Care Program, commonly referred to as Community Medicaid makes that an affordable and viable option.

Often we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets. In most instances, that is not the case.

Although an applicant for Community Medicaid must meet the necessary income and assets levels, often with planning we are able to assist in making an individual eligible with little wait. An individual who is applying for home care Medicaid may have no more than $14,850 in nonretirement liquid assets. Retirement assets will not be counted as a resource so long as the applicant is receiving monthly distributions from the account. An irrevocable prepaid burial fund is also an exempt resource.

The primary residence is an exempt asset during the lifetime of the Medicaid recipient. However, if the applicant owns a home, it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away.

With respect to income, an applicant for Medicaid is permitted to keep $825 per month in income plus a $20 disregard. However, if the applicant has income that exceeds that $845 threshold, a pooled income trust can be established to preserve the applicant’s excess income and direct it to a fund that can be used to pay his or her household bills.

It is important to note that there is no “look-back” for Community Medicaid. These pooled trusts are created by not-for-profit agencies and are a terrific way for persons to take advantage of the many services available through Community Medicaid while still preserving their income for use in meeting their monthly expenses.

Functionally, the way that these trusts work is that the applicant sends a check to the fund monthly for the amount that exceeds the allowable limit. Together with the check, the applicant submits household bills equal to the amount sent to the trust fund. The trust deducts a small monthly fee for servicing these payments and then, on behalf of the applicant, pays those household bills.

This process allows the applicant to continue relying on his or her monthly income to pay his or her bills and, at the same time, reduce the countable income amount to the amount permitted under the Medicaid rules. Once an individual is financially approved by the local Department of Social Services for Community Medicaid, he or she must enroll with a Managed Long-Term Care agency. This is the agency that will coordinate care services for the Medicaid recipient.

The MLTC will send a nurse to the Medicaid recipient in order to evaluate and create a care plan. The evaluation will result in an award of hours to the Medicaid recipient for a home health aide to come to the home and assist the recipient with activities of daily of living.

The amount of hours can vary from a few hours per day where the needs are less all the way to live-in care. This award of hours depends solely on the needs of the Medicaid recipient. If the Medicaid recipient is satisfied with the care plan, he or she may choose to enroll with the MLTC. Otherwise, he or she can request another evaluation with a different MLTC. What this means is that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period, allowing families to mitigate the cost of caring for their loved ones at home.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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By Nancy Burner, ESQ.

Nancy Burner, Esq.

For many, the question of how to best care for our aging loved ones becomes a reality sooner than we think. Most people, when given the option, would prefer to age in place, remain in their homes for as long as possible receiving the care services they need in a familiar setting surrounded by family. For many, the Community-Based Long-Term Care Program, commonly referred to as Community Medicaid, makes that an affordable and therefore viable option.

Oftentimes we meet with families who are under the impression that they will not qualify for these services through the Medicaid program due to their income and assets. In most cases, that is not the case. Although an applicant for Community Medicaid must meet the necessary income and assets levels, it is important to note that there is no “look back” for Community Medicaid. What this means is that for most people, with minimal planning, both the income and asset requirements can be met with a minimal waiting period, allowing families to mitigate the cost of caring for their loved ones at home.

An individual who is applying for Medicaid Home Care may have no more than $14,850 in nonretirement liquid assets. Retirement assets will not be counted as a resource so long as the applicant is receiving monthly distributions from the account. An irrevocable prepaid burial fund is also an exempt resource. The primary residence is an exempt asset during the lifetime of the Medicaid recipient; however, if the applicant owns a home, it is advisable to consider additional estate planning to ensure that the home will be protected once the Medicaid recipient passes away.

With respect to income, a single applicant for Medicaid is permitted to keep $825 per month in income plus a $20 disregard. However, if the applicant has income that exceeds that $845 threshold, a pooled income trust can be established to preserve the applicant’s excess income and direct it to a fund where it can be used to pay his or her household bills.

These pooled trusts are created by not-for-profit agencies and are a terrific way for persons to take advantage of the many services available through Medicaid Home Care while still preserving their income for use in meeting their monthly expenses.

Functionally, the way that these trusts work is that the applicant sends a check to the fund monthly for that amount that exceeds the allowable limit. Together with the check, the applicant submits household bills equal to the amount sent to the trust fund. The trust deducts a small monthly fee for servicing these payments and then, on behalf of the applicant, pays those household bills.

As you can see, this process allows the applicant to continue relying on his monthly income to pay his bills and, at the same time, reduce his countable income amount to the amount that is permitted under the Medicaid rules. An individual who is looking for coverage for the cost of a home health aide must be able to show that they require assistance with their activities of daily living. Some examples of activities of daily living include dressing, bathing, toileting, ambulating and feeding. In fact, where the need is established, the Medicaid program can provide care for up to 24 hours per day, seven days per week.

The Community-Based Medicaid Program is an invaluable program for many seniors who wish to age in place but are unable to do so without some level of assistance.

Nancy Burner, Esq. practices elder law and estate planning from her East Setauket office.

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