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Spousal Refusal allows the spouse living in the community to refuse to use his or her assets in calculating the eligibility of the spouse applying for Medicaid long term care. If one spouse requires nursing home care, the community spouse does not need to spend down all of his or her assets and become impoverished paying for care.

Question: My mother applied for Chronic Care Medicaid to cover her stay in a nursing home facility. At the time of her application she had an individual retirement account (IRA) in the amount of $11,000.00 and $2,000.00 in her bank account. I was informed that the resource allowance for Medicaid is $15,900.00 (2021). However, my mother was denied Medicaid for failure to “maximize” her IRA. What does this mean and was the Department of Social Services correct in its determination to deny Medicaid?

Immediate need Medicaid is an expedited application process to receive long term care at home paid for by Medicaid. Unlike the standard Medicaid application process, which can take approximately 6 months to receive services, those applying for immediate need Medicaid tend to receive care at home within one month of applying.

In order for an Irrevocable Medicaid Trust to be considered “exempt” for Medicaid purposes, it must provide that no principal distributions can be made to the grantor. This requirement ensures that the recipient did need Medicaid to cover the cost of her long term care, whether at home or in a nursing home facility. If the terms permitted distributions to the grantor or the trust was revocable, Medicaid would consider all assets in the trust as “available.” So using any money in the Trust for an assisted living facility is forbidden.

Question: My parents set up UTMA and 529 College Savings accounts for my children. I am not sure exactly what effect these accounts have on their financial aid in the future or whose assets they are if my parents need nursing home care.

Question: My mother has a trust that protects her house in case she needs long term care in a nursing home. Is this legal? Also, when she dies the trust is paid to another trust for me. Do I need this? I am only 53 and my mother is 75.

Community Medicaid, also known as homecare Medicaid, is not limited to care in one’s current home. A person is eligible for Community Medicaid so long as they reside in New York, do not require a skilled nursing facility, and meet the financial eligibility requirements.

When both spouses need long term care, they can apply together for Community Medicaid provided that they qualify as a “dual applicant.” As a couple applying for Community Medicaid, the spouses cannot have more than $40,821.00 in total countable resources.

A common question we get is, does Medicare pay for a nursing home? The Medicare program is administered jointly by the state and federal government. Medicare is available to adults 65 years of age and older, or to anyone under the age of 65 who is entitled to Social Security Disability.

When someone enters a nursing facility for long term placement, there are several ways the Chronic Medicaid program can treat the primary residence. Usually the primary residence is a “countable asset” for the Medicaid applicant and needs to be sold. However, there are some exempt transfer and planning techniques that can preserve the primary residence.