Chronic v. Community Medicaid
In New York, Medicaid can be a pay source whether you require care in your home or care in a Nursing Facility. The program which can help cover the cost of care in the home is referred to as Community Medicaid and the program which can pay for all or part of the cost of a Nursing Home is called Chronic Medicaid. Because Medicaid is a needs based program, certain income and asset requirements apply.
Community MedicaidIn order to be financially eligible for Community Medicaid the applicant can have no more than $14,850.00 in liquid, non-qualified (non-retirement) assets in his name. He may have retirement assets in an unlimited amount so long as he is taking a monthly required distribution as determined by the local department of social services. The primary residence is an exempt asset; however, it is important to consider asset planning if the applicant own a home. Although the home is exempt for eligibility purposes, there is a potential for estate recovery after the applicant passes away if proper planning is not undertaken. Finally, the applicant may pre-arrange and pay for his funeral expenses so long as the pre-payment is irrevocable. Personal property is exempt as is one car. With respect to income, a single applicant may have no more than $845.00 in monthly income; however, any income earned in excess of the $845.00 can be preserved for the applicant's use by creating and funding a Pooled Income Trust. One important thing to take note of is that the Community Medicaid program in New York has no look back. What this means for an individual living in the community is that he can undertake planning in one month and is immediately eligible for services the following month. This allows many of our clients to remain in the community, receive the care that they need while still managing to preserve their assets.
Chronic MedicaidIn order to be financially eligible for Chronic Medicaid, similar to Community Medicaid the $14,850.00 requirement also applies as does the rules regarding retirement assets and pre-paid funeral. When applying for Chronic Medicaid the home is not automatically exempt; however, there are certain circumstances where it is. Where there is a spouse, minor, disabled or caretaker child living in the home, the primary residence will be an exempt asset. Similarly where the Medicaid applicant has shown intent to return the home it will be exempted for a period of time. The income requirements are far more stringent. All income must be contributed to the cost of care, with $50.00 per month being exempted for the Applicant. Where there is a spouse living in the community earning less than $2,890.50 they can keep enough of their spouses' income to bring them to that level. Unlike Community Medicaid, when applying for Chronic Medicaid there is a five-year look back which means that the Department of Social Services will require full financial disclosure for the five years immediately prior to institutionalization and to the extent that any assets were transferred there is a potential that penalties will be imposed. It is important to note that certain transfers are exempted from this rule; among them are any transfers to spouses. Although the rules are complex, for many, the Medicaid program is an excellent program under which you can receive the care that you require and in many cases still manage to preserve some assets for your loved ones.