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.
Applicants applying for Community Medicaid can have up to $15,750 in their name, own their primary residence with an equity value of less than $898,000 (if single), and continue to maintain all tax deferred retirement accounts so long as they are in payout status. Any additional assets must be transferred out of the applicant’s name, either to a spouse, third party, or asset protection trust. If an applicant decides to move to another county within the state, such as moving in with a child, the applicant must notify Medicaid of the address change and provide them with any substantial changes in circumstance that may affect eligibility.
Any Medicaid recipient who moved counties does not have to reapply for services. The county must continue coverage through the month following notice. After that, the new county will pick up coverage. It is up to the counties to settle any disputes as they relate to the fiscal responsibility of the care, without having to involve the recipient. However, if the current home care agency does not operate in the new county, you will need to choose a new one that services that area.
Assisted living facilities, unlike nursing home facilities, still fall within the guidelines of Community Medicaid. In most assisted living facilities, your mother will be responsible for the cost of room and board, but she can receive personal long-term care paid for by Medicaid. The county in which she previously resided is the county that will cover the cost of her care, even if the facility is in a different county. There are also Medicaid Assisted Living Programs, which provide housing and long-term care services covered by Medicaid to those who would otherwise qualify for a nursing home, but whose needs can be met in a less restrictive manner.
It is important to note that we are currently in a transition period where the transfer of assets to qualify one for Medicaid services could create a penalty period during which Medicaid will not cover the cost of care. New York has implemented a 2.5-year lookback for all transfers made on or after October 1, 2020. The change is set to go into effect April 1, 2021. This means that an individual applying for Medicaid post-April 1, 2021, will have to submit 30 months’ worth of financial statements for eligibility purposes. To the extent there are uncompensated transfers or gifting that occurred on or after October 1, 2021, the applicant will be penalized and cannot be enrolled in homecare Medicaid during the penalty period. The hope, however, is that those needing Medicaid before April 1, 2021, will still be able to apply for homecare Medicaid without being subject to a lookback. Transfers to spouses are considered exempt transfers and are not subject to the lookback period.
Due to the complex nature of Medicaid and the current transition period, it is important to seek an Elder Law attorney with the expertise to help guide you through the system. For example, if a Medicaid recipient moves out of their residence, the home is no longer an exempt asset.