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New York State Community Medicaid

While Medicare is an exceedingly cost effective health insurance program, there are many significant gaps in coverage that have a way of swallowing up huge chunks of painstakingly saved retirement funds. Even when paired with a supplemental plan, Traditional Medicare, with its numerous deductibles, restrictions, and limited payment periods is far from a comprehensive health care solution.

To that end, Medicaid, a joint federal and state program was designed as a safety net to fill in for Medicare’s ever growing ‘doughnut hole’. New York currently offers two variations of Medicaid with long term care coverage:

1. Institutional Medicaid/Nursing Home Medicaid– where all a resident’s needs are provided for by a skilled nursing facility

2.  Community Medicaid for those who are interested in all the benefits aging in place has to offer, but require services beyond what Medicare offers, such as home care, home physical therapy, prescription drugs transportation to and from doctors appointments and the like.

It is important to note the distinction between community based care and nursing home coverage, as the rules and regulations vary considerably between programs.


Who Qualifies for NY Community Medicaid:

To qualify for NY community Medicaid one must

• Be a resident of the State of New York

• Be 65+ and/or disabled, or blind

• Meet the specified income and asset thresholds


Financial Requirements

A single person residing in the community can retain a monthly income of $845.00 and up to $14,850.00 worth of non exempt assets.

Dealing with Surplus

If a Medicaid recipient has surplus monthly income (any income above the allowed $845.00) they have 3 different ‘spend down’ options. Surplus income can either go toward medical expenses, be put into a Pooled Income Trust, or sent directly to the Medicaid provider to help offset the cost of care.

Medical Bills

If a Medicaid recipient has monthly medical bills that are more than or equal to the total surplus, Medicaid will disregard the excess income, and the recipient will still be eligible for benefits.

Pooled Income Trust

New York is unique in that the state recognizes that $845.00 will not go very far in terms of covering one’s living expenses, and allows those with surplus income to create a Pooled Income Trust. Once established, a Medicaid recipient can deposit monthly income in excess of the allowed $845.00 into the trust, and then submit living expenses to the trust for payment. The trust will then pay said bills accordingly.

Setting up a recognized and accredited Pooled Income Trust involves submitting a completed and properly signed Pooled Income Trust application to the local Medicaid Office. Paper work necessary for the application includes:

• An Executed Joinder Agreement

• A trust acceptance letter

• Verification of deposit

• The Master Trust paperwork

• LDSS-486T determination of disability (completed by the Medicaid recipients  PCP)

• MAP751E

• LDSS-1151 (disability questionnaire)

• A list of the Medicaid recipients medications

• Doctors notes from a recent visit

Contributions to the trust must be made on a monthly basis to keep it active, and there are expenditures that the trust cannot fund, but as a rule, one can preserve the bulk of his/her income, and still receive Medicaid benefits.

Medicaid Provider

Alternatively, if one’s monthly income exceeds the threshold by a minimal amount, they have the option of forgoing the Pooled Income Trust, and ‘spending down’ the surplus by sending it to their Home Care Medicaid Provider thereby contributing to the cost of care.

Look Back Period

When applying for Community Medicaid, the look back period is limited to just one month of financial scrutiny versus Institutional Medicaid, where Medicaid reserves the right to audit five years worth of financial history. Essentially this means that one can transfer their assets without an imposed penalty up to one month before they apply for Community Medicaid.

Attaining Resource Eligibility

If one does have excess resources within a month of applying for Community Medicaid, Medicaid will allow one to use the surplus toward medical bills and other recognized expenses such as an irrevocable trust fund for funeral and burial services.

Senior Planning Services:

Senior Planning Services focuses exclusively on the unduly frustrating and complicated Medicaid application process, and assists with everything down to the minutest aspects. With thousands of successfully approved applications under our belt and our unrivaled familiarity with the system, Senior Planning Services has earned a reputation as the industry experts.

Let us help you navigate the Medicaid maze and assist in your Community Medicaid application. Services we offer:

• We are multilingual and speak your language

• Guidance on the asset preservation and the spend down process

• Representation in the Medicaid Office

• Prevent unnecessary denials by submitting correctly completed applications

• Expedited approvals

• Assist in finding a home care provider that is right for you

• Assist in forming the Pooled Income Trust



Community Medicaid Overview

New York Medicaid in a Care Facility

New Jersey Community Medicaid