FAQ: Long Term Care Planning

What is Medicaid?

Medicaid is a joint federal and state program that provides health insurance to low-income individuals and families, including seniors, people with disabilities, pregnant women, and children. In New York State, Medicaid also offers coverage for long-term care services, such as nursing home care and home-based services, which are not typically covered by Medicare or private insurance. Eligibility for Medicaid is based on income and asset limits, which vary depending on the type of Medicaid program.

Medicare vs. Medicaid: What’s the Difference?

Medicare and Medicaid are both government-sponsored health insurance programs, but they serve different populations and have distinct eligibility criteria. Medicare is a federal program for individuals aged 65 or older and certain younger individuals with disabilities. It is not income-based and mainly covers hospital, outpatient, and medical services. Medicaid, however, is income- and asset-based and is designed to help low-income individuals and families. It also provides long-term care services, like nursing home care, which Medicare typically does not cover.

What types of long-term care does Medicaid cover in New York State?

New York Medicaid covers a wide range of long-term care services, including:

• Nursing Home Care: For both short-term rehab and long-term stays.

• Home and Community-Based Services (HCBS): Personal care aides, home health care, adult day care, and transportation through Managed Long-Term Care (MLTC).

• Assisted Living Program (ALP): Care in approved Medicaid-assisted living facilities (room and board may not be covered).

• Personal Care Services (PCS): Assistance with daily living activities like bathing and dressing.

• PACE: Comprehensive care to help seniors avoid nursing home placement.

What is Medicaid planning?

Medicaid planning involves strategies to protect assets and qualify for Medicaid, which provides health coverage for long-term care, such as nursing home care. The goal is to structure assets and income to meet Medicaid eligibility rules without depleting your life savings.

What is the Medicaid "look-back" period?

The Medicaid look-back period is the timeframe (30 months in NYS) during which Medicaid reviews your financial records to ensure you have not made disqualifying transfers to reduce assets. Any transfers for less than fair market value during this period can result in a penalty period of ineligibility.

Do I have to spend all my money before I can qualify for Medicaid?

No, you don't have to deplete all your assets. With proper planning, you can:

• Use exemptions (e.g., home, car).

• Convert countable assets into non-countable assets.

• Utilize tools like trusts and pre-paid burial plans.

What is a Medicaid Asset Protection Trust (MAPT)?

A Medicaid Asset Protection Trust is a legal tool used to protect assets from Medicaid’s spend-down requirements. By transferring assets into this trust, those assets are no longer counted as available resources for Medicaid eligibility, provided the transfer occurs at least 5 years (or the applicable look-back period) before applying for Medicaid.

Should I apply for Medicaid without planning ahead?

It’s not recommended to apply without planning. Doing so could result in penalties, delays, or denials of coverage. Planning in advance allows you to protect your assets and qualify for Medicaid without unnecessary financial hardship.

How far in advance should I begin Medicaid planning?

Ideally, Medicaid planning should begin at least 5 years before you anticipate needing long-term care. This allows you to transfer assets and avoid penalties related to the look-back period. However, there are still options for planning even if long-term care is imminent.

How can an attorney help with Medicaid planning?

An attorney experienced in Medicaid planning can:

• Evaluate your eligibility and advise on strategies to protect your assets.

• Assist with setting up trusts or restructuring assets.

• Navigate complex Medicaid applications and compliance with state-specific rules.

• Help avoid penalties by ensuring proper asset transfers and documentation.