Frequently Asked Questions Regarding Medicaid Planning
Medicaid planning is one of the most important but least understood aspects of elder law. You might have heard of it before and understand that it has something to do with paying for possible long-term care someday, but you still have a lot of questions about how it works. Our elder law attorneys at Enea, Scanlan & Sirignano, LLP, are here to address all your concerns and guide you through the process. Here are general answers to some of our most frequently asked questions about Medicaid planning.
What is Medicaid?
Medicaid is a federal health insurance program. Unlike Medicare, which is available to everyone age 65 or older, Medicaid is need-based and generally reserved for people whose income and financial resources fall below a certain threshold. However, it is possible to use tools such as trusts to qualify for Medicaid for help affording the high cost of living in an assisted living, nursing home or in-home care – without having to sell your belongings and leaving nothing for your heirs. This is where Medicaid planning comes in.
When should I start Medicaid planning?
Generally, the earlier in life you begin taking advantage of Medicaid planning, the easier it is. However, it is never too late. It is still possible to begin effective Medicaid planning later in life to save money.
What health care services are covered by Medicaid?
Besides nursing home care, Medicaid benefits in New York cover:
- Doctor visits
- Immunizations
- Lab tests and X-rays
- Hospital stays and emergency medical attention
- Vision and dental needs, such as eyeglasses and dentures
- Prescriptions
What assets are considered when determining Medicaid eligibility in New York?
When determining if an applicant qualifies for Medicaid, officials calculate how much the applicant owns in “resources” or assets. While many of your assets are counted, certain things are exempt. In New York state, exempt property includes your primary home and furnishings, vehicle, personal property such as your clothing, and IRAs and 401(k)s in payout mode. These exempt assets do not count against your total wealth, so you do not have to sell or give them away to qualify. The excess of your countable assets can be spent down, transferred to a new owner or placed into trust.
Can I give away assets to qualify for Medicaid?
This is trickier than you might think. Medicaid uses a look-back period of generally five years. Anything you gave as a gift or sold below fair market value in that time period to try to qualify for Medicaid would be counted against you. Also, giving away valuable assets as gifts to your children can trigger expensive taxes for them. For this reason, placing valuable assets in a specially designed trust is often a better option than giving them away to your loved ones.
How does the Medicaid “look-back” period work in New York?
New York has a five-year look-back period for Medicaid nursing homes, but currently, there is no look-back for Medicaid in-home care. During the look-back, Medicaid reviews financial transactions to identify asset transfers for less than fair market value. A penalty period is imposed if such transfers are found, delaying eligibility for Medicaid nursing home coverage. The penalty period is calculated by dividing the value of the transferred assets by the regional Medicaid nursing home rate.
What is a Medicaid Asset Protection Trust (MAPT), and how does it work?
A Medicaid Asset Protection Trust (MAPT) is an irrevocable trust designed to shield assets from Medicaid’s look-back period while allowing beneficiaries to qualify for benefits. Once assets are transferred into the MAPT, they are no longer counted as personal assets after five years (for nursing home Medicaid).
The trust can provide income to beneficiaries but prohibits the grantor from directly accessing the principal. A properly structured MAPT helps ensure that assets are preserved for heirs while allowing Medicaid eligibility.
How does spousal refusal work in New York’s Medicaid program?
Spousal refusal allows a nonapplicant spouse to refuse financial support for the applicant spouse seeking Medicaid.
This protects the community spouse’s assets and income, enabling the applicant spouse to qualify for Medicaid. New York Medicaid may attempt to recover costs from the refusing spouse, but legal strategies can help mitigate this risk.
What is the income limit for Medicaid eligibility in New York, and how can I qualify if my income exceeds this limit?
As of 2024, the income limit for a single applicant in New York is $1,732 per month for regular Medicaid and $1,732 for Medicaid home care (excluding certain deductions).
If income exceeds this limit, applicants can use a pooled income trust to shelter excess income while qualifying for Medicaid. This trust directs surplus income toward necessary living expenses rather than disqualifying the applicant.
What happens to my home if I need Medicaid for nursing home care?
A primary residence is exempt if a spouse, disabled child or caregiver child resides there. Otherwise, Medicaid may place a lien on the home and recover costs through estate recovery after the recipient’s death.
Strategies such as transferring ownership to a MAPT or utilizing spousal protections can help preserve the home from Medicaid claims.
Get Answers To Your Questions About Medicaid Planning In Westchester
A conversation with one of our Medicaid planning attorneys can help you get your questions answered and put your mind at ease. Contact Enea, Scanlan & Sirignano, LLP at our office in White Plains to schedule a legal consultation. Call 914-269-2367 to get started.
