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What is Medicaid?



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MEDICAID BASICS

     Medicaid is a New York State and Federally funded program to provide health insurance to those who qualify, not to be confused with Medicare.  Seniors qualify for Medicare immediately at 65 years of age regardless of income or assets. 

     There are two types of Medicaid which significantly help seniors and their families: Community Medicaid and Nursing Home Medicaid.  Eligibility for Community and Nursing Home Medicaid are income and asset based.  These income and asset levels are attainable for most regardless of your current finances.  

     The regional nursing home rate for 2018 in Dutchess, Orange, Rockland, Sullivan, Putnam, Ulster and Westchester Counties is $12,428 / month.  There is a 5 year look back period.  Your finances for the last five years will be scrutinized by the Department of Social Services.  


 Medicare Benefit for Nursing Home include but may be limited:

• 100% First 20 days (Hospital admission necessary)

• 80% the next 80 days

• Coverage ends after 100 days

• Approximate Daily Rate $164.50 / day

• Rehabilitation or Long Term Care treated equally


Nursing Home Medicaid / Transfers and Penalties

• 5 Year Look Back on all assets, transfers and gifts

• Unplanned transfers/gifts can result in penalty periods

• One month of penalty assessed for every $12,428 in uncompensated gifting or transfers.

Nursing Home Medicaid resource level for one individual cannot exceed $15,150.


Community Medicaid

• No look back period

• Covers health home aides or personal care aides based on individual needs

• Can be converted to Nursing Home Medicaid in the future

Community Medicaid's individual income level cannot exceed $825.00 with resource levels capped at $15,150.

The New York Medicaid Application, Access NY,  can be found at:  https://www.health.ny.gov/forms/doh-4220all.pdf


    Do not let these requirements discourage you.  Planning and strategy are key to Medicaid approval.  With proper Medicaid planning and preparation of your application, Medicaid is obtainable.