Medicaid Planning Lawyer in New York

For many families, Medicaid benefits represent the only means of affording long-term care for an elderly or disabled loved one. But only individuals whose incomes and assets fall below certain thresholds qualify for Medicaid. People whose assets exceed these limits need Medicaid planning to qualify for Medicaid benefits. That’s where a New York Medicaid planning lawyer from Amoruso & Amoruso LLP can come in.

If you and your family need help with Medicaid planning, contact Amoruso & Amoruso LLP. With nearly six decades of combined legal experience, our attorneys provide comprehensive estate planning, elder law, and Medicaid planning. We will take the time to get to know you and develop a holistic, personalized plan tailored to your needs and goals.

If you already have a long-term care Medicaid plan, allow Amoruso & Amoruso LLP to review it thoroughly. We’ll identify any areas that could use revisions or corrections and advise you on options for improving it based on your goals. Be assured that, if no changes are needed, we will tell you and you will have the peace of mind that your plan accomplishes your objectives.

What Is Long-Term Care?

Long-term care is the collection of services designed to help people meet their essential health and personal care needs as they age. Long-term care focuses on assisting with daily activities, such as bathing, toileting, dressing, eating, and moving around. Many people receive long-term care at home from family and friends. Professional home health care services also exist to provide in-home long-term care. Alternatively, people may move to an assisted living facility or nursing home to receive long-term care.

How Do You Pay for Long-Term Care?

Professional long-term care services at home or moving into an assisted living facility or a nursing home can become expensive. It is even more costly when a person needs long-term care for years or decades. Some of the most common methods that individuals and their families use to pay for long-term care include:

Long-term care insurance, which differs from traditional healthcare insurance. It covers the cost of long-term support services at home or in an assisted living or nursing facility; however, policies reimburse the cost of long-term care services up to a daily coverage limit.
Cash, which forces people to deplete their hard-earned retirement funds.
Medicaid, which is available to qualifying people whose assets and income fall within the Medicaid limits for New York to pay for long-term care.

What’s the Average Cost of Long-Term Care?

Based on our experience, average costs for standard long-term care services in New York include the following:

Approximately $14,000 to $18,000 per month for a room in a nursing home
Approximately $4,000 to $11,000 per month in an assisted living facility (depending on the level of care)
$25 to $32 per hour for a home health aide

Various factors can affect long-term care costs, including:

Geographic location
The time of day or week when hourly service providers come
Number of hours of care per day, per week
Level of care needed (unskilled personal care versus skilled care)
Whether assisted living facilities or nursing homes provide an all-inclusive rate or offer extra services

Does Medicare Cover All Long-Term Care or Nursing Home Bills?

Unfortunately, Medicare does not cover the cost of long-term care. Medicare will only provide limited coverage for skilled nursing services (i.e., physical, occupational, and speech therapy) for up to 100 days if eligible. Days 1-20 are free of charge, while days 21-100 have a 20 percent co-insurance. Thus, enrollees must cover 100 percent of the costs of non-covered long-term care. However, enrollees can turn to the Medicaid program to help with long-term care services.

How Do I Become Eligible for Medicaid Benefits?

People wishing to apply for Medicaid benefits must meet the eligibility requirements set by their state of residency. Recipients must be U.S. citizens or qualifying non-citizens, such as lawful permanent residents. Applicants must fall under one of several categories of individuals, including:

Children
Pregnant women
Certified visually impaired individuals

Certified disabled individuals
Individuals over 65

People with disabilities or those over age 65 must also meet the Medicaid program’s resource test. This test examines an applicant’s household income and assets. Also, an applicant’s assets or other financial resources must be under a limit that changes regularly to account for inflation. The amount of financial resources and income an applicant may possess also depends upon whether they seek Medicaid home care or nursing home Medicaid.

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Common Misconceptions About Medicaid Planning

Families who undertake Medicaid planning might have misconceptions about the planning process. Common misconceptions about Medicaid planning include:

Medicaid Is Only Possible by Giving Away Assets

Medicaid planning can involve a “spend down” strategy. This allows an applicant to spend their excess resources according to Medicaid rules.
Medicaid Planning Involves Unlawfully Hiding Assets

Families might think of Medicaid planning as “hiding” assets. However, Medicaid regulations allow applicants to make permissible transfers of their resources.
A Nursing Home Will Do It for Free

Nursing homes have little financial incentive to help residents engage in Medicaid planning, because they make more money off private pay residents.

A Medicaid Planning Company Can Do It for a Fraction of the Cost

Many companies offer services to help with the Medicaid planning process. However, they often lack the legal knowledge and cannot render planning advice, which is the unlawful practice of law.
It Is Too Late to Start Medicaid Planning

Even if an individual is already receiving long-term care at home or has been admitted to a nursing home, it is not too late. Medicaid planning can help them reach eligibility for benefits more quickly.

When Should I Apply for Medicaid in New York?

If you think you or a loved one will need Medicaid benefits to afford long-term care services, you should apply for Medicaid as soon as possible. You should apply even if you or your loved one might not meet the income and asset tests. Once approved, Medicaid coverage is effective as of the first day of the month in which the applicant was income and resource eligible.

What Could Make Me Ineligible for Medicaid?

The state agency may find you ineligible for Medicaid if you do not fall within one of the categories of people eligible to apply for the program. Some applicants are denied because they have income or assets that exceed the thresholds. Others are denied Medicaid coverage due to asset transfers made within five (5) years of filing their Medicaid application.

What Is Medicaid Planning?

A sound Medicaid plan enables a person to qualify for Medicaid benefits for long-term care while preserving assets that otherwise would render them ineligible for benefits. Medicaid planning involves implementing proven strategies to bring a person’s income and assets below the thresholds for Medicaid eligibility. Applicants with excess assets cannot qualify for nursing home or home care Medicaid.

Most importantly, however, as a nursing home Medicaid applicant, you cannot “give away” your property to qualify for benefits. Medicaid employs a five (5) year “lookback” rule to see if you made non-exempt transfers of assets. The state will conduct a “five-year lookback” when reviewing a nursing home Medicaid application. The lookback checks whether you have disposed of or transferred away assets without receiving adequate compensation for those assets. The Department of Social Services deems such transfers to have been made solely to qualify for Medicaid benefits. If so, a period of benefit ineligibility will be imposed based on the value of the transfer, which would require you to privately pay for all of your long-term care expenses during that timeframe. It should be noted that while New York currently does not use a lookback period for home care Medicaid, the law provides for a thirty (30) month lookback period to begin in New York on March 31, 2024, unless that law is repealed.

Non-qualifying transfers usually include any transfers of assets for less than fair market value. These include “gifts” to family members, charities, and friends.

Why You Need an Elder Law Attorney for Medicaid Planning

An elder law attorney from Amoruso & Amoruso LLP has the experience and knowledge to guide you through the complex and confusing Medicaid planning process. Our lawyers know the law, eligibility requirements, and strategies for spending down assets. We can help you craft a plan to ensure you or a loved one can afford long-term care at home or in a nursing home. In addition, we can review your circumstances to identify tailored strategies that meet your needs. An effective plan will minimize financial disruption and help you or your loved one preserve your assets.

When Is a Medicaid Crisis Plan Needed?

If you do not have a Medicaid plan in place and you or your loved one has a diagnosis or health crisis, we call this Medicaid crisis planning.

Suppose your spouse has a stroke and is hospitalized. If he or she is discharged to a nursing home for rehabilitation but becomes a long-term resident, how will you pay for it? If a loved one becomes forgetful and begins wandering away from home but then gets lost and unable to find their way home, you may need to hire one or more home care aides. With private aides charging $25 per hour or more, how will you afford this cost?

Families should create a Medicaid crisis plan in case a loved one suddenly requires long-term care or admission to a nursing home due to a catastrophic injury or sharp decline in health. A single individual who needs long-term care at home or to live in a nursing home may need a Medicaid crisis plan if they have income or assets above Medicaid’s permissible amounts. A Medicaid crisis plan allows applicants and their families to draw down or preserve assets and resources before applying for Medicaid. This protects assets from being depleted on long-term care and allows the well spouse access to them to live in the community.

Of course, a better plan of action is to engage in Medicaid planning before the crisis hits.

Contact a New York Medicaid Crisis Planning Attorney Today

Medicaid benefits can help you or a loved one get the care you need without sacrificing all your hard-earned assets and resources. However, qualifying for Medicaid requires careful planning. Let a New York Medicaid planning attorney from Amoruso & Amoruso LLP help you and your family plan for the future.

Contact us today to review your options for qualifying for Medicaid benefits, based on your needs or your loved one’s needs. Because at Amoruso & Amoruso LLP, we are focused on Empowering You to Care for the Ones You Love™.

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