Medicaid eligibility requirements in New York are based on income, assets owned, age, disability status, and household size. Applying for Medicaid can be a complicated process, but the program can be a financial lifesaver, especially for low-income adults, adults over age 65, pregnant women, and individuals with permanent disabilities.
Medicare is a government-sponsored healthcare insurance program that covers routine health care, emergency care, and prescriptions. However, it does not cover the full cost of long-term nursing care.
To be eligible for Medicaid in New York, applicants must be U.S. citizens or meet specific immigration rules, be residents of the state and county where the Medicaid application is submitted, and have a social security number.
Financial Eligibility for Medicaid
The Affordable Care Act of 2010 introduced a new way to determine Medicaid income eligibility that led to increased coverage for nearly all low-income adults under age 65. For most Medicaid applicants, financial eligibility is based on their Modified Adjusted Gross Income (MAGI).
Financial eligibility is based on the following factors:
- Taxable income (regular benefit payments, veterans benefits, salaries, wages, interest income, dividends from stocks and bonds)
- Tax filing relationships
Adults 65 and older are exempt from MAGI-based income-based eligibility rules.
Asset Limits for Medicaid Eligibility
Medicaid eligibility also depends on having assets valued below a certain threshold. Some assets are counted, while others are excluded.
Assets that are typically counted include the following:
- Checking and savings accounts
- Retirement accounts
- Stocks and bonds
- Certificates of deposit
- Real property other than a primary residence
- Having more than one vehicle
While the value of your home is not counted under assets, as long as it is your primary residence, it can impact whether Medicaid will pay for long-term care services, including nursing home care and home and community-based services. In New York, Medicaid may attempt to seek reimbursement for your long-term care expenses by filing a claim against your estate after your death.
The full value of jointly owned accounts and assets may be used when determining Medicaid eligibility because either account owner has full access to the value of the asset or account.
Medicaid-Covered Long-Term Care
New York adults over age 65 may be eligible for the following Medicaid managed care long-term care plans:
- Institutional/nursing home care: covers extended stays in medical facilities
- Medicaid waivers/home and community-based services: covers routine appointments, emergency care, prescription medications, home health care, physical therapy, and home health aid services.
- Regular Medicaid: People with disabilities or blindness or adults over age 65
New York residents over age 65 must meet the income threshold and other requirements to qualify for Medicaid long-term care plans. The 2024 requirements include:
- Income under $1,732 per month
- Assets valued at under $30,182
- Assessments indicating a nursing home level of care
Medicaid has a 60-month look-back period during which officials review applicants’ financial transactions over the previous 60 months to determine eligibility for long-term care. This policy is intended to prevent people from giving away their accounts or assets or selling them at below fair-market value to qualify for Medicaid. Some states, such as California, are an exception to this policy.
If violations are found, a penalty period during which a Medicaid applicant is not eligible for benefits is imposed.
Specialized Medicaid Programs for Older Adults
Specific Medicaid programs are available for adults over age 65, each with its requirements. For example, the Elderly Pharmaceutical Insurance Coverage (EPIC) Program is available for income-eligible New York residents over age 65 to supplement their Medicare Part D drug plan costs.
Integrated Care Plans are also available for people who qualify for both Medicare and Medicaid benefits. These programs cover Medicare benefits and include home care and other long-term services and supports.
An attorney specializing in elder law can help with the Medicaid eligibility process. Your estate planning attorney can help you consider all your options and develop a plan that meets your potential long-term care needs as part of a comprehensive estate plan. We have extensive experience in planning to maximize income and assets to meet your financial needs.
Give us a call today at 866-395-1786 or contact us online to schedule a meeting and discuss your unique financial needs. Let us be your trusted partner on the path to financial success.