Medicaid Recertification: Why Legal Guidance Matters

Q: I Received a Notice That My Medicaid Needs to Be Recertified. Should I Talk to an Elder Law Attorney? 

Having an experienced elder law attorney overseeing the Medicaid application and recertification processes can certainly better one’s chance of achieving and maintaining Medicaid eligibility.

Medicaid Asset and Income Limits for 2026

For 2026, Medicaid has imposed an asset limit of $33,038 for an individual applicant or $44,796 if both spouses are applying for long term care services. For community-based services, Medicaid’s income limit is $1,836 per individual applicant and $2,489 per couple. With proper planning, income beyond the limits can be maintained to continue to support the expenses of the household.

Medicaid Transfer Rules and the Five-Year Lookback

While there are no transfer penalties imposed for home care applicants that have given assets away prior to application, nursing home applicants do have to undergo a five-year lookback review. While most transfers/gifts will result in a penalty period during which Medicaid will not pay for the facility, certain asset transfers will be exempt. Whether both spouses are applying for coverage or just one, the finances of both must be disclosed.

Does Medicaid Require Recertification?

Once someone has been accepted into the Medicaid long term care program for Community Medicaid (in-home care) or Chronic Medicaid (nursing-home care), they will be required to recertify annually. The recertification process ensures that the applicant remains eligible for coverage. The annual review requires updated asset and income verification for the Medicaid applicant, not the spouse.

Sometimes Medicaid recipients experience an increase in their assets as a result of standard accrual of interest on assets, receiving inheritance, or accepting proceeds from a lawsuit. An attorney can advise what estate planning can be done to prevent ineligibility or a lapse in benefits. Recertification can also prompt determining whether a recipient is receiving the appropriate level of care.

Why Navigating Medicaid Requires Careful Planning

As of the beginning of January 2026, there are 3,812,810 Medicaid recipients within the five boroughs and 662,136 Medicaid recipients in Nassau and Suffolk counties. Medicaid applications and recertifications are processed by each county’s Department of Social Services or Human Resources Administration for those receiving care in the five boroughs of New York City.

Due to the volume of applications and recertifications, and the millions of dollars expended by the state to provide Medicaid, the system can be unforgiving. Working with an elder law-focused estate planning attorney can help individuals achieve and/or maintain eligibility, while also protecting hard-earned assets, so they can eventually be passed onto the next generation.

Recertification also provides the opportunity to review your assets and estate plan. A key estate planning goal for a Medicaid recipient and their spouse is to avoid probate because whatever assets are includable in a deceased Medicaid recipient’s probate estate will be subject to a claw back from Medicaid for services provided during life. Proper planning includes protection of assets for eligibility purposes as well as after death to prevent recovery of the value of the services rendered during life.

By Erin Cullen, Esq. and Britt Burner, Esq.

Erin Cullen, Esq. is an associate attorney at Burner Prudenti Law, P.C. focusing her practice areas on Trusts and Estates. Britt Burner, Esq. is the Managing Partner at Burner Prudenti Law, P.C. focusing her practice areas on Estate Planning and Elder Law.  Burner Prudenti Law, P.C. serves clients from New York City to the east end of Long Island with offices located in East Setauket, Westhampton Beach, Manhattan and East Hampton.