2006-09-22 / Columnists


On Elderlaw Major Changes To Medicaid Program
By Nancy J. Brady, RN, Esq. And Linda Faith Marshak, Esq.

On Elderlaw

Major Changes To Medicaid Program

By Nancy J. Brady, RN, Esq.
And Linda Faith Marshak, Esq.

There have been major changes to the Medicaid program in New York State this year with the passage of the Deficit Reduction Act. Most of the changes affect the "look back" and "penalty" periods for nursing home benefits. Without advance planning (five years before nursing home is required) it will be increasingly difficult for individuals to protect assets. We recommend individuals begin planning as early as possible, with the advice of an attorney well versed in the Medicaid rules.

With the exception of prescription drug coverage, home care Medicaid benefits have not undergone any major changes thus far. If an individual has done no prior planning for long term care, the home care Medicaid program may provide an alternative to nursing home placement.

The Medicaid program is for the elderly, blind or disabled individuals who meet the eligibility requirements. There are asset (savings, checking, IRAs, life insurance, etc.) limits and income (monthly checks) in order for one to receive benefits through the program, as well as medical eligibility criteria. Home care benefits are available to provide up to twenty four hours of home attendant services if the individual qualifies. Through a special program, it is possible to hire the aide of one's choice, provided they are qualified to work in this country, and are not a spouse or child of the Medicaid applicant. This is called the Consumer Directed Personal Assistance Program.

The application process is detailed and time consuming. The individual can have no more than $4150.00 in total assets for at least one month prior to the application being submitted. The income limit is $692.00, plus an additional $20.00 for individuals over age 65, plus the cost of any secondary health insurance premiums. If the income is in excess of these amounts, the individual can still receive benefits, and Medicaid will bill them monthly for the excess. If the excess income is deposited into a Medicaid qualifying pooled income trust, the Medicaid recipient has the option to use the excess income to pay bills on his or her behalf. This option which has been available for the last couple of years involves a great deal of paperwork initially, however once in place our clients have been using this program with no problems.

With regards to the amount of home attendant hours available, there is a medical information form which must be submitted with the application for benefits. This form must be completed in great detail to ensure a clear picture of the individual's needs so that he or she is approved for the necessary amount of hours on the initial approval. If enough hours are not approved, a fair hearing can be requested, however the hearing process is lengthy and should be avoided if possible.

Individuals aged 60 and above should strongly consider a consultation with an experienced elderlaw attorney to develop and implement a plan to protect their assets in the event nursing home care is needed. As previously stated, in order to be eligible to apply for Medicaid for nursing home care, planning should be done five years in advance.

This information is a brief overview, and is intended for informational purposes. Any individual who is in need of planning or long term care services should seek the advice of an attorney who actually prepares and submits applications and obtains Medicaid benefits for their clients, to develop a plan specific to his or her particular situation. Do not rely on the advice of others who may or may not be well educated with regards to the eligibility rules and the application process. Legal fees incurred in exploring the options available can save thousands of dollars in long term care expenses.

The attorneys can be reached at 718-945-7777 to schedule a consultation or obtain information regarding upcoming seminars.

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