Welcome to Homecare Advisory Group! We offer invaluable home care insights and guidance to help you navigate your health care options. Understanding Community Medicaid eligibility, especially for the aged, blind, and disabled individuals, is essential for getting the care you need. This guide will walk you through what Community Medicaid covers and how to determine if you qualify.

The following provides an overview of Community Medicaid and Community Medicaid with Long-Term Care:
  • What is Community Medicaid?

    Community Medicaid is a health insurance program designed to cover essential healthcare services for eligible individuals. These services include doctor visits, hospital stays, lab tests, and prescription medications. Community Medicaid is of particular importance to individuals aged 65 and older, those certified as blind by the Commission for the Blind and Visually Handicapped, and those certified as disabled by Social Security or the State of New York.

    One key aspect of Community Medicaid is its ability to work alongside Medicare. While Medicare covers a significant portion of healthcare needs, Medicaid steps in to cover the gaps, ensuring comprehensive healthcare coverage. For those who already have Medicare, Medicaid does not directly pay for prescription drugs. Instead, it provides a free Medicare Part D prescription drug plan through Medicare, ensuring that beneficiaries have access to necessary medications.

  • What is Community Medicaid with Long-Term Care?

    Community Medicaid with Long-Term Care is an extended form of Community Medicaid that includes additional benefits. Along with the standard health insurance features of Community Medicaid, it also offers long-term care services within the community. These services can include home care, adult day care, and assisted living programs. In New York, this extended form of Medicaid also includes the Consumer Directed Personal Assistance Program (CDPAP), which allows individuals to have more control over their home care services.

    This extended coverage ensures that individuals who need extensive care can receive it without having to leave their homes. This is particularly beneficial for seniors and disabled individuals who wish to maintain a level of independence while receiving the care they need.

  • Eligibility Requirements for Community Medicaid

    Medicaid is a means-tested program, which means it is designed to assist individuals with low income and limited resources. To determine eligibility for Community Medicaid, two main financial factors are considered:

    1. Income: This includes regular incoming money such as Social Security payments, pensions, or income from IRAs.
    2. Resources: This includes assets such as savings, stocks, bonds, real estate, or undistributed IRAs.

    Here are the current income limits for Community Medicaid:

    – $1,677 per month for an individual

    – $2,268 per month for a couple

    Applicants receive a $20 disregard on unearned income, slightly increasing these limits to $1,697 per month for an individual and $2,288 per month for a couple.

    The current resource limits for Community Medicaid are:

    – $30,180 for an individual

    – $40,820 for a couple

    Applicants who are not seeking long-term care coverage can declare their assets without providing documentation. However, if you seek long-term care coverage, you must provide documentation of your resources. Traditionally, the significant difference between standard Community Medicaid and Community Medicaid with Long-Term Care was the requirement for resource documentation. 

    New York State plans to implement a “Look-Back Period of 30 Months” for applicants of Community Medicaid with Long-Term Care. This means that applicants who transferred assets as gifts within this period may face penalties, which could restrict their access to Medicaid Long-Term Care services. This look-back period is anticipated to start no earlier than March 31, 2024.

  • Exceeding the Community Medicaid Limit

    If your income or resources exceed the Community Medicaid limit, there are several strategies you can use to still qualify for the program. These strategies include:

    1. Health Insurance Premiums: Payments for health insurance premiums are disregarded when calculating your income for Medicaid eligibility.
    2. Pay-In and Spend-Down: You can pay the excess amount over the income limit to Medicaid or use excess income to cover medical bills. Once the excess income has been used to cover these expenses, you can then qualify for Medicaid benefits.
    3. Earned Income: For aged, blind, and disabled individuals, earned income is treated more favorably. After a $65 disregard, the remaining income is divided by two. For example, if you earn $1,065 per month, Medicaid will deduct $65, leaving $1,000. This amount is then divided by two, resulting in a budgeted earned income of $500.
    4. Pooled Income Trust: Another common strategy is depositing excess income into a pooled income trust owned by a disabled individual. In New York, excess income in such a trust is disregarded for Community Medicaid purposes. The funds in the trust can be used to pay bills but cannot be withdrawn as cash.
    5. Holocaust Restitution Payments: Payments for Holocaust restitution are completely disregarded when calculating Medicaid income.
    6. Medicaid Recipients Enrolled in Managed Long-Term Care (MLTC): Spouses of individuals enrolled in MLTC plans may have a combined income of up to $4,306.50 per month. This allows for more favorable income budgeting either as single applicants or by utilizing the Minimum Monthly Maintenance Needs Allowance (MMMNA).

  • For Individuals with Resources Above the Medicaid Limit

    If your resources exceed the Medicaid limit, there are ways to qualify without reducing your assets significantly:

    1. Homestead: Your primary residence is exempt from consideration if its equity value is within the limit of $1,033,000. Medicaid can still recover from the residence’s equity after the recipient’s death, but spouses or children under 21, or blind or disabled children living in the home are exempt from this recovery.
    2. Holocaust Restitution Payments: Like income, payments received for Holocaust restitution are considered exempt resources. This allows you to retain these funds without affecting Medicaid eligibility, regardless of how long you have been receiving them.
    3. Spousal Impoverishment Allowance: If your spouse is a Medicaid recipient enrolled in an MLTC plan, you can qualify for a resource allowance equal to half of your combined assets up to $137,400, in addition to the recipient’s $30,180 resource allowance.

  • Important Considerations

    While this guide provides a basic overview of Community Medicaid eligibility, it does not cover advanced strategies like asset transfers or spousal refusal. An asset transfer involves moving assets to another person’s name to reduce your countable resources. 

    Spousal refusal, on the other hand, involves the non-applying spouse refusing to provide financial support for the applying spouse’s Medicaid eligibility. Both strategies can have significant legal and financial implications and should be considered with the help of a legal professional or a Medicaid planning expert. It is always recommended to consult with a Medicaid planning expert or legal professional to understand your specific situation fully and to get the best possible advice tailored to your needs.

  • How We Can Help

    Applying for Medicaid can be a complex and daunting task, especially given the strict eligibility requirements and various strategies available to manage income and resources. To make this process easier, we provide free assistance with Medicaid home care applications.

    If you need help for yourself, a loved one, or a client, we are here to support you. Our team is knowledgeable about the latest rules and regulations and can help you navigate the application process with ease.

  • Contact Us

    For more information or to receive assistance with your Medicaid application, get in touch with us today. We are dedicated to providing you with the guidance and support you need to secure the right healthcare coverage.

    This guide is intended for informational purposes only and should not be taken as legal advice. Always verify information and consult with professionals when necessary. For further details about our home care agency in NY, please refer to the full disclaimer at the bottom of our page.