Dec 3, 2021 New York Medicaid Income Limits
Medicaid is a federally established program providing subsidized healthcare services to qualified individuals who can not afford to pay for private health insurance, medical care, home care, or long-term nursing care. Although Medicaid was created by an act of Congress in 1965, the program is administered by each state’s government agencies, some of which supplement the federal benefits with state funds.
New York’s Medicaid program maintains several different service levels and eligibility requirements for applicants with special circumstances such as pregnant women, financially challenged students of all ages, people who are certified blind, children under 21, and others. For our purposes in this blog post, we’ll focus primarily on disabled residents and on seniors who are 65 year of age and older.
The key to understanding New York’s Medicaid program coverages and services is to remember that there are two levels of Medicaid: Institutional (Chronic) Medicaid, or nursing home care, and Community Medicaid or home care. The income limits and resource caps for eligibility are a bit different for each plan.
Difference Between Institutional Medicaid and Community Medicaid in NY
The difference between Institutional and Community Medicaid is reflected in their names.
Institutional (Chronic) Medicaid is the plan covering the needs of those whose medical condition requires institutional care, like long term care in a nursing home. The expenses incurred in providing 24-hour nursing home care are higher than typically spent providing services to recipients living in the community. As a result, the eligibility limitations on income and financial assets for nursing home care are more restrictive.
Community Medicaid provides funds to support NY residents whose care level allows them to reside at home with assistance, in a relative’s home, or in an assisted living facility. Community-based care can also require substantial funds to pay for in-home personal care aides, average daily living (ADL) support, cooking, bathing assistance, and similar services. But, more lenient resource (asset) and income limits apply to Community Medicaid recipients because the cost is lower than required for institutional long-term care.
2021 Income and Resource Limits
To be eligible for a group of benefits under NY Medicaid, an applicant or recipient must have a limited income to qualify for benefits. Contact Ely J. Rosenzveig & Associates, PC, for the new adjusted figures for 2022.
Single Person 65 and Older or Disabled in Nursing Home (Institutional) Medicaid: An applicant for Institutional (Chronic Care) Medicaid is eligible for benefits to pay for nursing home care only if the applicant’s income is less than the cost of nursing home care. If an applicant’s nonexempt income is less than the nursing home private-pay cost, then they are eligible for Medicaid to provide funds for their care.
In that event, all of a person’s available monthly income would be paid to the nursing home, except for a $50 personal needs allowance (PNA) plus $20. The exception to this would be if the applicant has a spouse in the community – someone who is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA), as discussed below.
Resource Cap: The financial resource cap for single Institutional Medicaid applicants in 2021 is $15,900, but some financial resources may be exempt. For example, there is a primary homestead exemption up to the value of $906,000.
**If you think you or your family member may be approaching an age where full-time, long-term institutional nursing home care may be needed, we recommend that you consult with the experienced elder law attorneys at Ely J. Rosenzveig & Associates as soon as possible.
Institutional Medicaid has a five-year look-back period during which any asset transfers are scrutinized to ensure they qualify for Medicaid exemption. If not, then a Medicaid penalty period can be imposed, during which time the Medicaid applicant is deemed ineligible for Medicaid benefits, and must use his own assets to privately pay for his care.
Couple Eligibility and Spousal Refusal: For 2021, when a couple needs Institutional Medicaid benefits for only one spouse who needs nursing home care, NY Medicaid provides for a spouse living in the community to have income up to $3,259.50 as the Community Spouse’s Monthly Maintenance Needs Allowance (MMNA). If the community-based spouse’s income exceeds that amount, then they are required to contribute 25% of the excess toward the institutional spouse’s nursing home expenses.
The non-institutionalized spouse is also entitled to retain a community spouse resource allowance (“CSRA”) that, depending on the circumstances, ranges between $74,820 and $130,380.
However, if the community-based spouse’s income substantially exceeds the MMNA threshold,, or his/her assets exceed the CSRA limits, New York regulations allow them to exercise Spousal Refusal, which permits that spouse to opt out of contributing toward the nursing home care costs of the institutionalized spouse. This may ultimately engender a Medicaid claim against the non-institutionalized spouse. However, the exposure is limited to the Medicaid rate of pay, a number substantially lower than the nursing home private-pay rate.
Community Medicaid Benefits: Eligibility for Community Medicaid, including for those who live at home, or with a relative, or in an assisted living facility, is limited to those whose income is no more than $884 (+ $20) per month. Remember, some income is exempt from being counted for Medicaid eligibility purposes.
Financial resources (assets) that may exceed the Medicaid resource limit for Community Medicaid—i.e., $15,900 (the same threshold as for Institutional Medicaid) may be preserved via an asset protection trust. Another option to protect assets and remain Medicaid eligible is a Pooled Trust.
Our experienced elder law attorneys at Ely J. Rosenzveig & Associates can help you successfully navigate the complex Medicaid eligibility and asset protection rules and regulations to ensure that you and your loved ones receive all the care that they need while preserving your assets and income to the full extent that the law allows.
ALERT: The New York legislature recently created a look-back period for the first time on asset transfers by Community Medicaid applicants, thar as noted above, will ultimately grow to 30 months. Originally scheduled to become effective in July 2021, the effective date was delayed until April 2022 and may be put off again until July 2022.
The new 30-month look-back period for will not apply to those who apply for Community Medicaid benefits before the effective date. Contacting an estate planning and Medicaid lawyer now is advisable.
Please note: Even with the look-back periods referenced above, there are still certain exempt transfers that can be utilized for some. Additionally, even if planning was not done in advance of any imposed look-back period, there are still options – even in a crisis situation when care is needed immediately.
Find Out How Medicaid Benefits and Regulations Apply to You
New York’s Medicaid rules and regulations contain many more exceptions and special terms that apply to people whose personal circumstances differ. Some benefits are recognized as “entitlements” while others are not. Available benefits may even vary from county to county when local public programs or community resources are provided.
Attorney Ely J. Rosenzveig and his associates are eager to guide you through the Medicaid maze and help you implement the best plan for you and your family. Please don’t wait. Call today.