Community Medicaid Eligibility

What is Community Medicaid?

Fundamentally, Community Medicaid is health insurance. Yes, financial eligibility is required for both income and resources. In 2024 the limit an applicant can have in resources is $31,175 and $1,732 monthly income. If the applicant meets the financial requirements he/she can apply for Community Medicaid. Suppose the applicant requires home care services, where a home attendant would visit the applicant on a daily basis and assists them with their Activities of Daily Living (ADLs), such as, getting dressed, toileting, shower, cooking, and feeding, etc. These services are all part of what Community Medicaid has to offer.

The question always asked is what if the applicant has more than the allowed income and resources? Many advisors will tell the applicant to spenddown their life savings before they can apply. Technically speaking it’s an option, but lets explore another option and see if it makes sense for you to choose the later of the two.

Resources:   Today and up until Medicaid implements the new regulation, applicants can transfer their life savings to anyone, including but not limited to a trust, and become financially eligible the very next month.  Once the new regulation goes into effect Medicaid will impose 30 months or two and one-half (2.5) years of look-back. This does not mean a two an one-half (2.5) years of ineligibility, but if any money was transferred during the look-back period there will be some ineligibility period imposed.  Once the new law is in place additional strategies will be offered to applicants to choose from in order to protect some or all of their life savings.

Income:    Suppose the applicant has income from several sources, such as, social security, pension and IRA’s that distribute the required minimum distribution. Lets assume the total is approximately $3,000 per month. Here the applicant has a choice. Either (1) surrender the difference ($3,000 less $1,732), which is $1,268 to Medicaid or (2) join a Medicaid approved pooled-income-trust and deposit the $1,268 on a monthly basis. By joining a pooled-income-trust the applicant is allowed to use the money in the trust to pay their bills, such as, rent, cable, credit card, etc.

Care:    Although many applicants are under the impression that Medicaid has its own staff of unqualified home-attendants, it is far from the truth and incorrect. This concept forces potential applicants to prefer a more skillful attendant from a private agency. However, in reality Medicaid has no home attendant! Medicaid hires the private agencies to provide the services. As a matter of fact, the applicant can sometimes keep the same agency and same home attendants they presently have or choose anyone of the many private agencies who are registered with Medicaid.

Conclusion:   If the services are provided by the same attendant that the applicant would pay up to $35 an hour today through a private agency why deplete the applicant’s life savings when they could be protected and used for additional care or services which Medicaid does not provide.

We at Elder Care Services, Inc., file applications in NY County, which includes, Manhattan, Brooklyn, The Bronx, Queens and Staten Island, as well as, Nassau, Suffolk, Westchester, Rockland, Putnam, Orange, Sullivan and Dutchess Counties.