Asset Spend-Down: Your Path to Medicaid Eligibility in NY

Understanding Medicaid in New York

Medicaid is a program designed to provide healthcare coverage to low-income individuals, families, and children in New York who meet certain income and resource criteria. Eligible populations include children, pregnant women, single individuals, families, and individuals who are certified blind or certified disabled. Even if their income and resources exceed the allowable Medicaid levels, individuals with significant medical bills may still qualify for Medicaid.

Medicaid Eligibility Criteria

In New York, eligibility for Medicaid is determined based on income and resource limits. Certified blind individuals, certified disabled individuals, and individuals over 65 are subject to a resource test in order to qualify for Medicaid. On the other hand, children and families may be eligible for Child Health Plus or Family Health Plus if they do not meet the Medicaid criteria.

The income and resource levels for Medicaid in New York generally change on January 1 of each year. It's important to stay updated on these changes, as they may impact your eligibility.

Applying for Medicaid in New York

To apply for Medicaid in New York, individuals can choose to apply through NY State of Health or their Local Department of Social Service (LDSS) depending on their category of eligibility. Representatives will assist applicants in determining the correct location to apply. It is recommended to contact the New York State Health Department's Growing Up Healthy Hotline at 1-800-522-5006 or reach out to their local county Department of Social Services for more information. In New York City, individuals can call the Information Hotline at 311 or (718) 557-1399. Additionally, more information about Medicaid in New York is available on the Medicaid website [1].

Understanding the eligibility criteria and the application process is crucial when considering Medicaid in New York. By familiarizing yourself with the requirements and seeking guidance from the appropriate channels, you can navigate the Medicaid application process more effectively.

Asset and Income Limits

To qualify for Medicaid in New York, individuals must meet certain asset and income limits. These limits are set to determine financial eligibility for Medicaid benefits and vary based on individual circumstances.

Asset Limits for Medicaid

When applying for Medicaid in New York, individuals need to be mindful of the asset limit. As of the latest update in 2022, the asset limit for a single Medicaid recipient in New York was $16,800, while for a couple it was $24,600. Assets include funds and property that can potentially cover care costs out of pocket, even if it involves selling most possessions. It's important to note that certain assets, such as the applicant's primary home, household goods, personal effects, prepaid burial funds, and a vehicle that meets specific criteria, are exempt and not counted towards Medicaid eligibility.

Income Limits for Medicaid

In addition to asset limits, individuals applying for Medicaid in New York must also meet income limits. These limits consider funds from various sources, including pensions, rent, investments, wages, and Social Security income. The income limits are set at extremely low levels to determine financial eligibility. In 2022, the monthly income limit for an individual applying for Medicaid was $934, while a married couple applying could not exceed $1,367 in net income per month [2].

It is important to consider that Medicaid has different rules and regulations regarding income and asset limits for different categories of applicants, such as the elderly, disabled, or pregnant individuals. Consulting with a Medicaid planning professional can provide further guidance on navigating these limits and ensuring eligibility for the program.

Medicaid Excess Income Program

For individuals in New York who have income that exceeds the Medicaid level, there is still an opportunity to qualify for assistance with medical bills through the Medicaid Excess Income program. This program, also known as the "Spenddown program" or "Surplus Income program," allows individuals to demonstrate that their medical expenses are equal to or exceed their excess income in a particular month, thereby qualifying them for additional Medicaid coverage for that month.

Overview of the Excess Income Program

The Excess Income program is designed to assist individuals who fall into specific eligibility categories, including those who are under 21, 65 or older, certified blind or disabled, pregnant, or a parent of a child under 21. These individuals can qualify for Medicaid even if their income exceeds the limit.

The program operates by allowing individuals to apply their medical expenses toward their excess income. To qualify, individuals must demonstrate that their medical bills meet or exceed their excess income amount for a particular month. Medicaid coverage will then be extended for the remainder of that month, covering additional medical bills. This enables individuals with higher incomes to still receive the necessary medical assistance they require [3].

Qualifying for the Excess Income Program

To qualify for the Excess Income program, individuals must submit their paid or unpaid medical bills to their local department of social services each month in which Medicaid services are needed. Only bills that meet or exceed the excess income amount should be submitted. These bills can include expenses for services such as outpatient care, doctor visits, dental visits, lab tests, prescription drugs, and long-term care in the community, such as home care and assisted living.

It's important to note that past paid medical bills can also be applied toward the Excess Income program if the services were provided and paid for within the three calendar months before the month of applying for Medicaid. These bills can be used to meet excess income for up to six months, including retroactive coverage for recent medical bills.

By participating in the Excess Income program, individuals with higher incomes can still access the necessary medical coverage they need. It's vital to keep track of medical expenses and submit relevant bills to the local department of social services to ensure qualification and continued coverage under the program. The Excess Income program provides a pathway for individuals to receive the assistance they require, even if their income surpasses the Medicaid limits.

Spend Down Assets for Medicaid

When it comes to qualifying for Medicaid in New York, individuals with assets that exceed the allowable limit can still become eligible through a process known as a spend down. This section will explore what a spend down is and how medical expenses can be used to meet the spend down requirement.

What is a Spend Down?

A spend down is a method used to "spend down" excess assets to meet the asset limits required for Medicaid eligibility. In New York, the asset limits for Medicaid vary depending on the applicant's eligibility category. By strategically spending down assets to meet these limits, individuals can qualify for Medicaid coverage.

To initiate a spend down, individuals must complete the application form DOH-4220 and a supplement form DOH-5178A, which are available in multiple languages. It is important to note that individuals who receive medical services paid for by Medicaid on or after their 55th birthday or while permanently residing in a medical institution may have those costs recovered from their assets in their estate upon their death. It is advisable to consult with a professional to ensure compliance with Medicaid rules and regulations.

Using Medical Expenses for Spend Down

Under the Medicaid Excess Income program, individuals with income that exceeds the Medicaid level can qualify for assistance with medical bills. This program, also known as the "Spenddown program" or "Surplus Income program," allows individuals to demonstrate that their medical expenses for a particular month are equal to or greater than their excess income. Medicaid will then cover additional medical bills for the remainder of that month.

To meet the spend down requirement, individuals can use past paid medical bills that were provided and paid for within the three calendar months before the month of applying for Medicaid. These bills can be applied toward the Excess Income program for up to six months, including retroactive coverage for recent medical bills.

It's important to keep detailed records of medical expenses, including receipts, invoices, and statements, to accurately demonstrate the amount spent on qualifying medical bills. This documentation is crucial when applying for Medicaid and going through the spend down process.

By understanding what a spend down is and how medical expenses can be used to meet the spend down requirement, individuals can effectively navigate the Medicaid application process and maximize their chances of qualifying for the necessary assistance. Consulting with professionals who specialize in Medicaid planning can provide further guidance and assistance in efficiently managing the spend down of assets.

Medicaid Planning Strategies

When it comes to qualifying for Medicaid in New York, individuals may need to employ specific strategies to meet the asset and income limits required for eligibility. Two common Medicaid planning strategies include asset transfer considerations and life care planning.

Asset Transfer Considerations

As individuals navigate the Medicaid application process, they may consider asset transfer as a way to meet the asset limits while preserving some of their resources. However, it's important to note that New York has a 60-month "look back" period for Medicaid applicants seeking nursing home care. During this period, financial transactions are reviewed, and any assets sold or given away for less than fair market value may result in a penalty period of Medicaid ineligibility.

To ensure compliance with Medicaid regulations, individuals should consult with Medicaid and life care planning attorneys who can provide guidance on asset transfer strategies that align with the rules and avoid penalties. These professionals can help individuals develop a comprehensive plan to protect their assets while still qualifying for Medicaid benefits.

Life Care Planning for Medicaid

Life care planning is another Medicaid planning strategy that individuals can explore to navigate the qualification process without depleting all of their personal assets. Life care planning attorneys specialize in helping individuals qualify for Medicaid benefits while safeguarding their assets and ensuring they receive appropriate care.

These professionals work closely with individuals and their families to create personalized plans that address their specific needs and goals. They assess financial situations, explore available Medicaid programs, and develop strategies to allocate resources effectively. Life care planning attorneys can also provide guidance on long-term care options, including nursing homes, assisted living facilities, and home care services.

By engaging in life care planning, individuals can navigate the complex Medicaid eligibility requirements while maximizing the utilization of their assets for their long-term care needs. This approach allows individuals to plan for their future, protect their assets, and ensure they receive quality care.

It is crucial to seek professional advice from Medicaid and life care planning attorneys who have expertise in New York Medicaid regulations to ensure compliance and make informed decisions regarding asset transfers and life care planning strategies. These professionals can help individuals understand the intricacies of the Medicaid application process, maximize their eligibility, and protect their financial well-being.

Recent Changes and Considerations

As with any government program, Medicaid eligibility and requirements can undergo changes and updates. It's important to stay informed about recent developments to understand the impact on Medicaid eligibility in New York.

Impact of COVID-19 on Medicaid Eligibility

The COVID-19 pandemic has had a significant impact on Medicaid eligibility in New York. The COVID public health emergency, extended multiple times up to April 2022, resulted in temporary changes to Medicaid rules and regulations [2]. These changes have affected the "spend-down" process and other aspects of Medicaid eligibility.

One of the key impacts of the COVID-19 pandemic is the temporary suspension of the 30-month look-back period for home care and minimum requirements for Consumer Directed Personal Assistance Program (CDPAP) services. This means that applicants who complete Medicaid planning and submit their Home Care Medicaid Application before October 1, 2022, may not be subject to the standard 30-month look-back period or penalties for transfers to a Medicaid Asset Protection Trust. These temporary changes aim to provide assistance and flexibility to individuals seeking Medicaid benefits during these challenging times.

2022 Updates on Asset and Income Limits

In 2022, there were updates to the asset and income limits for Medicaid eligibility in New York. These limits are essential in determining an individual's financial eligibility for Medicaid benefits.

For asset limits, the threshold for a single Medicaid recipient was set at $16,800, while for a couple, it was $24,600. These limits help assess if an individual has sufficient resources to cover care costs by selling most of their assets, ensuring financial eligibility for Medicaid benefits.

When it comes to income limits, in 2022, the monthly limit for an individual applying for Medicaid in New York was $934. For a married couple with both spouses applying, the net income limit per month was $1,367. These income limits play a crucial role in determining financial eligibility for Medicaid benefits.

It's important to note that these asset and income limits can be subject to change, so it's essential to stay updated on the latest regulations to ensure accurate understanding and planning.

Understanding recent changes and considerations related to Medicaid eligibility helps individuals navigate the complexities of the program and make informed decisions regarding their healthcare coverage. By staying informed and seeking guidance from professionals experienced in Medicaid and life care planning, individuals can effectively navigate the eligibility requirements and explore alternative options without depleting all their personal assets.

References

• ‍https://www.health.ny.gov/publications/0548/medicaid.htm
• ‍https://www.ricafortelaw.com/library/medicaid-eligibility-in-new-york.cfm
• ‍https://www.health.ny.gov/healthcare/medicaid/excessincome.htm
• ‍https://www.health.ny.gov/healthcare/medicaid/howdoiapply.htm