Does Community Medicaid Pay for Nursing Home Care?

CommunityMedicaidv_ChronicMedicaid201695633576
*Updated August 24, 2020

Community Medicaid and Nursing Home (Chronic) Medicaid are two different programs that cover long term care. Community Medicaid will not pay for long term care in a nursing home.  Community Medicaid is the program that covers care at home; such has a home health care aide.  Chronic Medicaid is the program that covers nursing home care.  The requirements and application process for Community Medicaid and Chronic Medicaid are very different.  An individual is unable to receive both Community and Chronic Medicaid simultaneously so it is important to know the differences and make sure you have the correct Medicaid in effect.

For 2020, an individual applying for Community Medicaid can have no more than $15,750.00 in resources and the primary residence is an exempt resource. Qualified funds such as IRAs or 401(K)s are exempt, but the applicant is required to take required minimum distributions which are counted as income each month. Additionally, the medicaid recipient cannot have more than $875.00 per month in income. However, in New York State we utilize Pooled Income Trusts to capture the excess income.

This is much different than Chronic Medicaid.  For 2020, an individual applying for Chronic Medicaid can have no more than $15,750.00 in resources, including a home, and no more than $50.00 per month in income.  There is no pooled trust option to protect the excess income.  Like Community Medicaid, qualified funds such as IRAs or 401(K)s are exempt, but the applicant is required to take periodic distributions which are counted as income each month.

Both programs now have a look back period for any transfers made prior to applying for Medicaid. Up until October 1, 2020, Community Medicaid did not have a look back period at all, but because of changes in the law, a thirty month (2.5 years) look back will apply. Chronic Medicaid has a five year look-back.  The look-back refers to the period of time that the Department of Social Services will review your assets and any transfers that you have made.  To the extent that the applicant has made transfers or has too many assets in their name to qualify, they will be ineligible for Medicaid.  However, there are some exempt transfers that the applicant can make which will not render them ineligible.  If transfers were done in order to qualify the individual for Community Medicaid, those same transfers may prose an issue for a Chronic Medicaid application.

Due to the differences in Community and Chronic Medicaid requirements and regulations, it is imperative to consult an expert.

Nancy Burner, Esq. and Brittni Sullivan, Esq.

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Burner Law Group, P.C.

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