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How Needs are Assessed for Medicaid Long Term Care Eligibility

by | Apr 25, 2022 | Medicaid Planning For Nursing Home And Home Health Care Expenses |

Despite thoughtful retirement planning, many people struggle to pay for long-term care in their later years. Individuals may have generous pensions, social security, and retirement funds, but find that the cost of home care or nursing home care can quickly exhaust their resources.

Medicaid is a joint federal/state program. New York has incorporated and contributes to most of the Medicaid programs offered by the federal government.  However, one must not only be medically ready for care, but financially eligible. This requires planning at the appropriate time, not during a crisis.

Requirements for Medicaid long-term care

According to information from AgingCare, the median national rate for a nursing home private room runs over $100,000 a year. New York has among the highest rates in the nation. On Long Island, Medicaid has determined that average cost of a nursing home is $14,012.00 per month or $467.00 per diem for a 30-day month.

Universal requirements for Medicaid include holding the status of U.S. citizenship and meeting state residency rules. Applicants must also exceed 64 years of age or have a qualifying disability. A needs assessment determines if the person requires care in a nursing home or an assisted living facility.

Financial requirements

Even if a person meets the health requirements for skilled nursing care, he or she must also meet certain financial requirements. State Medicaid programs set strict limits for assets and income. In terms of assets, some holdings do not count toward these limits including one vehicle, prepaid burial assets, and assets held in certain trusts. The home is preserved only if the applicant or spouse is there. However, reimbursement for Medicaid services will be sought if the Medicaid recipient is the surviving spouse and the home is not in a trust.

New York requires that an applicant for Community Medicaid or Chronic Care Medicaid (nursing home Medicaid) have no more than $16,800.00 in countable assets to qualify for these benefits. Applying for long-term care Medicaid benefits typically involves a lengthy process and is best accomplished with the assistance of an elder law attorney/estate planning attorney.

We have been successful for over 25 years in obtaining Medicaid eligibility for our clients and, also successful in appealing Medicaid benefit decisions for our clients. Our firm will not only assist you in planning to cover costs for long-term care but provide optimal preservation of your estate for inheritance by your heirs.

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