Important requirements of Medicaid that you should know

Estate planning is an essential step to ensure your wishes are executed after you pass, but as individuals age, it’s also important to consider the possibility of long-term care due to a prolonged illness or disability. According to the Kaiser Family Foundation, one out of three seniors 65 or older will need long-term care at a skilled nursing facility.

The average cost per day for a nursing home stay in New York ranges from $325 in Central New York to nearly $700 in Long Island. That figure jumps to over $160,000 annually.

If you are considering home health care, those costs can run $27 – $35 per hour. Even if you have outstanding health insurance, you may come up short. Medicare will cover some home health care costs, but Medicaid can cover around-the-clock skilled nursing care in your home.

Why you may need Medicaid

If you are considering a nursing facility for yourself or a loved one, you should know that Medicare does not cover long-term care. You may have the resources to pay these costs out of pocket, or perhaps you invested in long-term care insurance, but if you are like 60% of nursing home residents, you may need the help of Medicaid to cover your expenses.

Medicaid is need-based, which means it is awarded according to your available assets. You may have to spend down your assets in order to qualify. Proactive medicare planning can often provide eligibility while protecting the family’s assets.

Can you transfer your assets to other family members to qualify for Medicaid?

Yes, but under very specific conditions. You cannot sign over all your assets and immediately apply for Medicaid. Instead, assets must be transferred to other family members prior to Medicaid’s “look-back” period, typically five years before applying to Medicaid. If you transfer a high-value asset during the look-back period, your coverage can be delayed for months or even years. If you try to transfer the assets at less than market value, Medicaid will not approve your application.

Medicaid qualifications get complex when a surviving spouse is not moving into long-term care funded by Medicaid. Medicaid may ask the spouse to contribute to the cost of their care.

Qualifying for Medicaid

To be eligible for Medicaid, you must meet the eligibility requirements. For 2023, the resource limit is $28,134 for single applicants and $37,908 for married couples. These resources include any liquid asset owned by the applicant. Monthly income can not exceed $1,563 for a single applicant and $2,106 for married applicants. The eligibility requirements for Medicaid can seem complex, so planning ahead with the help of a professional can provide some assurance and security that your application will be approved without delays.

FindLaw Network