Immediate Need Medicaid


Question: My mother has been in a rehabilitation facility for the last 6 weeks and will be discharged any day now.  She is unable to care for herself and we desperately need help at home. I want to apply for Medicaid to help pay for the care, but I heard this can take months.  Is there a way to get the care in place faster?

Answer: There are two ways to get homecare Medicaid in place.  The first is to submit a regular Medicaid application, which often takes several months before the care is put in place.  Assuming your mother is already financially eligible for Medicaid, the first step is to collect documentation for the application.  If your mother is not yet financially eligible, there are several ways to shelter her assets that an elder law attorney can assist you with.  Once the application is submitted, the local department of social services will determine her eligibility.   After eligibility is determined, there is a series of nursing assessments to determine if your mother requires long term care and what amount of hours will be covered. 

In 2015, New York passed a law to help speed up the process and get homecare within weeks for those who have an immediate need for care.  Under immediate need Medicaid, a determination of eligibility must occur no later than seven days after the local department of social services receives a completed application.  The regulations state that the local department should have the care in place within twelve days of receipt of the application, assuming she is approved.  The approval process and care placement are to occur concurrently, not consecutively. The department cannot wait until they receive the results of financial eligibility before assessing mother and determining the hours of care she is to receive once approved for Medicaid.

Immediate need Medicaid is a great option for those who not only show a current need for care, but also for those who have few resources and are unable to pay for care within the home.  It also relieves loved ones from assuming the financial responsibility of paying for supplemental care during the period of time when a standard Medicaid application is under review.  However, it is important to note that unlike regular Medicaid, once approved for immediate need, the applicant will be auto assigned into a home health care agency that will provide the aides in the home.

Regardless of the method you choose, mother must still meet the financial requirements in order to first be eligible for Medicaid.   Under the 2018 resource limit, mother can have up to $15,150 in resources, which include bank and brokerage accounts, non-qualified retirement accounts, and real property not including mother’s primary residence.  A qualified retirement account, such as an IRA, is an exempt resource and not calculated as part of the resources of the applicant.

There is also a Medicaid monthly income cap, however, the mere fact of having income above the cap should not deter one from applying for care.  Many applicants receive income in excess of this amount with their social security benefits alone.  Thankfully, if mother has income in excess of this amount, all is not lost.  Mother can join a Pooled Income Trust and deposit her excess income in this trust, the sum of which can be used to pay for her monthly expenses.

Getting mother financially qualified for Medicaid, applying for Medicaid, and getting the care in place may require guidance from a legal professional.  I strongly advise contacting an elder law attorney to discuss your options and determine the best route for you and mother to take.

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Burner Law Group, P.C.

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