Applying for Medicaid can be a very confusing process. In New York State there are two types of Medicaid benefits, Community Medicaid and Chronic Care Medicaid. The eligibility and application requirements are different, as are the benefits provided by each program.
Community Medicaid benefits cover low income recipients as their primary health insurance and also cover elderly/disabled persons who require home care and health services in the community. Community Medicaid eligibility requirements for income and resources are constantly changing and are different for singles and couples. An elder law attorney can suggest planning methods to conserve resources and excess monthly income involving Pooled or Special Needs Trusts.
Chronic Care Medicaid covers the costs of an individual who needs permanent skilled nursing home care. A chronic care application requires a look-back of sixty (60) months. This means the applicant must provide all monthly financial account statements for the past five (5) years to the local Social Service Agency in order for the application to be complete.
Due to the nature of very specific Medicaid rules and regulations and the fact that various County’s application of the rules differ, it is often an attorney’s experience in the area that allows for successful navigation of the system. It is possible for clients to research general information however, unlike other areas of law, if documents specific to the applicant’s County are not provided, the application can be denied, which could affect the applicant’s eligibility date. Because the monthly cost of private pay at a nursing home is high, $10,000 – $13,000 per month, a one month denial of eligibility can be a very expensive issue. Also, Counties may differ as to time allowed applicants to submit additional information required or the number of extensions of time to submit missing documentation, which can also result in a denied application.
What’s more, an elder law attorney can devise and help families implement a comprehensive estate and Medicaid plan that often saves applicants thousands of dollars. This can include lawful techniques to preserve assets after a client is in the hospital or nursing home.
Another complication that an elder law attorney can help you navigate is prior gifting of assets. Chronic Care Medicaid rules require a transfer penalty if gifts were made by the applicant (or spouse) within the five (5) years prior to applying for Medicaid.
Each case must be assessed and tailored to an individual’s needs, taking into account costs and benefits including gift, estate, and capital gains tax implications. Unfortunately, it is all too likely that clients who initially did not want to pay for fees associated with using an attorney to file a Medicaid application end up paying higher fees to engage an attorney to “fix” a denied application, or they end up paying more to the nursing home for private pay if a determination of Medicaid eligibility is opened after the application date.
Admitting a loved one to a skilled nursing facility can often be a time of crisis and confusion. Obtain competent legal advice by an attorney in our Elder Law practice area to help you avoid a period of Medicaid inability that can cost thousands.