Community Medicaid Planning for At-Home Care and Adult Day Care Programs

Long Island Alzheimer's and Dementia Center’s state-of-the-art day program is now contracted to receive payment through the Community Medicaid program. Community Medicaid encompasses both home care and day care versus institutional Medicaid which refers to skilled nursing facility residential care. Even if you are receiving home care hours through Medicaid, Long Island Alzheimer's and Dementia Center’s day program can be worked in to your hours of coverage.

Community Medicaid looks at both income and resources when determining an applicant’s eligibility. To clarify, income is any money that is coming in regularly such as a pension, Social Security or a distribution from an IRA or other retirement account.  Resources are assets that the Medicaid applicant has in their name such as checking, savings, money market, stocks, brokerage accounts, bonds, etc.  Even if the account is held jointly with another individual, Medicaid counts the total account value towards the resources of the applicant.  Currently a single applicant for Community Medicaid cannot have resources in excess of $15,450 and they cannot have monthly income in excess of $859.  A married couple who are both applying cannot have more than $22,800 in total resources and their total monthly cannot exceed $1,267.  Do not be discouraged if your income and/or resources are above these Medicaid limits.  Legal techniques such as trusts, life estates and pooled trusts can help you accomplish your goals of qualifying for these benefits. In New York, Medicaid home care and adult day care benefits are available with only a one month look-back period. However, it is important to be mindful of possible future institutional Medicaid benefits in the event nursing home care is ever needed and appropriate planning should be pursued.

Even if you do not plan on ever seeking nursing home care, it is vital to understand how Medicaid works and seek the professional experience of a Medicaid/Elder Law planning attorney. Failing to do so could result in you being penalized in the future for decisions you make today with the best of intentions.  Early planning is the key to preserving your assets, allowing you to make lifetime gifts to family members or to a trust, thereby assuring your assets will not be spent down on the costs of your health care or paid to the government. The current look-back period for institutional Medicaid is five years, meaning that individuals and families must plan five years before a health care crisis occurs.  

Now is the Time to Schedule a Consultation

It is never too early or too late to plan.  Depending on whether you’re applying for community or institutional Medicaid benefits, there will be different records required. Therefore in order to be prepared for a consultation, you should locate the following documents:

1. Deed to real property or condominium and a copy of the most recent Real Property Tax Bill

2. Cooperative apartment stock certificate, proprietary lease and Maintenance Statement

3. Information regarding health insurance, including copy of identification card and evidence of monthly premium

4. Information regarding life insurance policies, including face value and current cash surrender value of policy

5. Tax return(s)

6. Statements for all accounts in which the applicant has or had a financial interest, including, but not limited to, checking accounts, savings accounts, passbooks, CD’s, stocks, brokerage accounts, annuities, treasury bills and bonds.

7. Copies of the following documents:  (Required for applicant and spouse if spouse is living, even if spouse is not applying)

8. Trusts                    

9. Last Will and Testament

10. Power of Attorney, Health Care Proxy and Living Will

11. Pre-paid funeral contract and/or cemetery deed

Find out more about Medicaid eligibility and how this can work for you and your loved ones by clicking here.