Medicaid can be such a complex program to fully understand, particularly with the clients that I typically work with. The program in itself has specific criteria that must be met in order to qualify for the benefits. Here are some things to consider that often come up a lot in conversations with my clients majority of whom are older and dealing with chronic illness. Why the question about Medicaid? Well it’s simple, as far as receiving ongoing home care services it truly is the only program that offers assistance for folks in need of someone to assist them regularly with their care needs. Recently in NYS there have been major changes to the Medicaid program that impacts those with chronic medical conditions who are looking for this type of assistance. For more information about these changes, check out this article for specific details.
In the meantime if you want a crash course on basic Medicaid criteria keep reading for additional info. This is meant to give you a brief overview of the program as it relates to New York State. Please note that Medicaid varies from state to state. If you aren’t in the New York area I would highly recommend you check your local Department of Social Services website for additional information. Moving forward within this post I am only providing insight into the Medicaid program as it relates to New York State and those who are disabled with chronic illness & those 65+ .
MEDICAID GUIDELINES
Changes annually but it is income and asset/resource-based. For example, on a monthly basis, your income should not exceed a specific amount to qualify for benefits. Although there are exceptions to the rule we will get more into this a little later in this post. Monthly income includes benefits from social security, pensions, annuity payments. Assets and resources include: ALL bank accounts, retirement accounts such as IRA’s, properties especially those outside of your home, think rental properties, a home you may have cosigned on many years ago that you DO NOT live in.
If you want to get the maximum benefits of Medicaid you must enroll in a specific plan. Think similar to an HMO. A few years ago with the passing of the affordable care act, many medical providers enrolled in managed Medicaid plans. It is extremely difficult to find a provider willing to accept straight Medicaid. If you happen to have Medicaid without any managed plan you should contact the providers you are interested in to determine which plans they accept to maximize your health benefits.
Remember earlier I mentioned there were exceptions to the Medicaid rules and monthly income? For those looking for ongoing assistance particularly those that are disabled and or 65 and older it is important to explore whether or not you would want to participate in the spend-down or surplus program. This allows you to be eligible for Medicaid if your income is in excess of the allowable amount. For folks that are retired and or have an extensive history, this can be very problematic in the sense that what if your income is over by hundreds even thousands of dollars over the amount? This is where people may decide to explore enrollment into a Pooled Income Trust. More information on that here.
Initially, when I started writing this post I wanted to include that there have been major changes to the Medicaid rules and regulations with regard to the lookback period which began in October 2020. However, it seems as though these changes have been delayed which is a good thing especially for those looking to explore the possibility of Medicaid for the purposes of obtaining ongoing help with day-to-day activities in their home. Note that based on this article which was also referenced earlier these changes have been delayed so it is important to keep in mind these can change yet again. I encourage my clients to explore all their options and it is ALWAYS a good idea to consult with an ELDER CARE ATTORNEY. They are such a valuable resource especially if you find a good one and they can assist you to make an informed decision about the care of a loved one. Ask for recommendations so that you can find a reputable one that can assist you.
Worried about the costs associated with an elder care attorney? I always encourage folks to think outside the box and explore unlikely resources to obtain assistance. For example, do you have access to legal services through your employer? Does your loved one have a union benefit? It may be beneficial to reach out and ask if they offer legal services including access to an elder care attorney so that you can get some additional support.
At the end of the day, it is an expensive investment but could be worth the benefits in the event that you or a loved one is in need of additional care needs that will NOT be met through traditional health insurance plans.
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