Feb 18, 2022 Chronic Medicaid vs. Community Medicaid in New York State

Medicaid is a healthcare insurance program jointly funded by the federal government and the state, but administered by the state agencies. In New York, the Medicaid program had 7,333,635 people enrolled in 2021. The cost of the program is projected to be $83 billion in 2021-2022 fiscal year, of which $27.8 billion is paid by New York.

To organize this immense program, NY Medicaid developed a number of different programs to focus on the diverse healthcare needs of various groups of benefit recipients. One of the major distinctions exists between what we call “Chronic Medicaid” and another category of coverage we call “Community Medicaid.”

Overview of the Difference — Chronic vs. Community Medicaid

Applying for Medicaid in New York can be confusing because of the numerous programs. The two most confused programs are Chronic Medicaid and Community Medicaid. Each program implements different eligibility criteria and offers different coverage.

The Chronic Medicaid program handles the claims for people who need chronic or long-term institutional care in facilities like nursing homes and other hospital-like settings. Chronic Medicaid is sometimes referred to as Institutional Medicaid.

Community Medicaid is the program that manages claims for healthcare and related services provided to people at home or in other community settings, including needs for long-term community-based care, adult day healthcare, some assisted-living centers, personal care aides to help with activities of daily living, and skilled visiting nurses.

NY Medicaid Income Limits and Financial Resource Caps

The Medicaid program pays for the high costs of institutional and long-term nursing home care (Chronic Medicaid) and for a multitude of at-home or assisted living facility services and expenses. Because of the mounting expense of healthcare services for elders, aged 65 and older, and disabled residents, eligibility for Medicaid health insurance coverage is restricted by income and asset caps, as well as “look-back” periods for transfers of assets.

Working with an experienced elder-law attorney at Ely J. Rosenzveig & Associates can, with the proper planning, ensure access to Medicaid coverage even for those whose income and resources exceed the Medicaid eligibility caps.

2022 Income and Resource Limits for Chronic and Community Medicaid: The eligibility rules for New York Chronic Medicaid and Community Medicaid include the following income and financial resource limits:

• Monthly Income Limits
  • $934 for single person
  • $1,637 for a married couple, both spouses applying for Medicaid coverage
  • $934 for a married applicant where only one spouse is applying for Medicaid coverage
• Financial Resource Limits
  • $16,800 for single
  • $24,000 for a married couple, both spouses applying for Medicaid coverage
  • $16,000 for married applicant spouse and $137,400 for non-applicant spouse

The Chronic Medicaid rules require that all the Institutional Medicaid recipients’ income be paid over to Medicaid to cover the costs of the nursing home care, except for $50 personal needs money. The Chronic Medicaid program does have various exceptions when a non-applicant spouse needs funds to prevent them from becoming destitute.

Is Your Home Safe from Medicaid Spend Down Requirements?

Chronic Medicaid covers extremely expensive full-time institutional nursing home care and can require an applicant to sell their home, and spend down their financial resources, until they meet the program’s financial eligibility levels. If a spouse or minor child, or a disabled or caretaker child resides in the house, or if the applicant intends to return home, the house would be exempt from Medicaid imposition, and would not be counted as an available resource for Medicaid. Otherwise, it is available for Medicaid spend down before a Medicaid applicant could begin coverage.

If the Chronic Medicaid applicant’s home is exempt based on a spouse or child living there, the death of the last qualifying resident can open the home up to a Medicaid claim for reimbursement.

Community Medicaid, on the other hand, exempts (in 2022) up to $955,000 of the applicant’s home value and does not count it as an available resource.

In either case, transferring the home to one of several possible trusts will eliminate it from Medicaid’s reach if it is done before the 5-year “look-back” period for Chronic/Institutional Medicaid coverage, or up to a two and a half year “look back” period for Community Medicaid (should a look back period for community Medicaid be implemented later this year).

Asset Transfer Look-Back Periods

For many years, only Chronic Medicaid applicants were subjected to a Medicaid review to determine if the applicant transferred any financial assets within the previous 5 years. This is called the 5-year “look back.” If an applicant did transfer property or financial resources within that time, those transactions could trigger a penalty period during which Medicaid denies coverage.

*Now, for the first time beginning on July 1, 2022 (unless delayed again), NY Community Medicaid will impose a “look-back” period on program applicants. The “look-back” period will start at 21 months. Each month after July 2022, the “look-back” period will reach back an additional month until the final Community Medicaid “look-back” period is 30 months, or two and a half years.

Preserving Medicaid Eligibility while Protecting Your Assets — Trusts

Planning for the financial demands of aging in America is a necessity if you want to avoid spending away all your savings and property to pay for the care of a loved one. Expenses for long-term nursing care, at home or in an institutional setting, will drain financial resources quickly. Unless you purchased a private long-term-care insurance policy or have unlimited funds, Medicaid is the last best option to meet uncovered healthcare expenses.

Ely J. Rosenzveig and Associates specializes in the protection of your financial assets while preserving your eligibility for Medicaid coverage. Among the most effective instruments the law provides to protect assets from Medicaid and from estate taxes is a trust.

Transferring assets into a Medicaid Asset Protection Trust in advance of when Medicaid may be needed permits the trust creator (trustor or settlor) to preserve income producing assets and property for their own or someone else’s benefit. By transferring title to the trust, the asset is no longer owned by the Medicaid applicant or their spouse and is not counted by Medicaid to disqualify the donors from coverage.

At Ely J. Rosenzveig and Associates, we can help you find the right trust for your life and circumstances.

Contact our experienced elder law and trusts & estates attorneys at Ely J. Rosenzveig and Associates to learn more about how you can retain your financial assets and still qualify for both NY Chronic Medicaid and Community Medicaid.

Call Ely J. Rosenzveig and Associates today: 1 (914) 816-2900
or email us at: [email protected]