New York Connects provides helpful information to frequently asked questions about Medicaid to help you plan for the future.
WHAT IS MEDICAID?
Medicaid is a program for New Yorkers who can't afford to pay for medical care. Often times people needing home care and skilled nursing homes will need to apply.
WHAT IS NEEDED TO APPLY FOR LONG-TERM CARE OR A NURSING HOME THROUGH MEDICAID?
The current laws require that a person applying for these services under Medicaid submit 60 months' worth of the following documentation from the date of application:
1. Copy of power of attorney
2. Birth certificate, baptismal certificate or driver's license
3. Marriage certificate - if spouse deceased, copy of death certificate; if separated or divorced, proof of separation or divorce
4. Verification of present address with shelter expenses or proof of residence prior to admission to nursing home
5. Last 4 pay stubs if employed
6. Award letter or photocopy of most recent check for:
Social Security/ Railroad Retirement
Pension or retirement
Union benefits/workmen's compensation benefits
New York state disability insurance
Court ordered support/ alimony payments
7. Rental Income - verification of amount received, tax bills, maintenance and repairs and utilities paid
8. All bank and credit union checking and savings account transactions- for open and closed accounts
9. Explanation and proof (including receipts and canceled checks) of all withdrawals and deposits over $1,000 for bank accounts, investments, retirement plans, annuities
10. Life insurance policies, verification of current cash values and name of beneficiary
11. Vehicle registration and title for all vehicles in household. If sold or transferred within last 60 months, provide documentation
12. Stocks, savings bonds, securities- even if currently closed or surrendered - and any transactions with in the last 60 months
13. IRAs/employee-related pension funds/Keogh plans/401 K statements - for the last 60 months
14. Burial fund agreement/current bank statement
15. Deed to all property owned - if life use or real estate in property - must see the transfer deed
16. Current proof of mortgage/escrow, tax bills, and homeowners insurance - on all properties owned
17. Income tax returns for the last 5 years - including all 1099s
18. Original annuity contracts and verification of any income received. Annuities are subject to a 60-month review.
19. Trust documents and amount of principal and interest. Can principal be invaded? Limitations, if any? Trusts are subject to a 60-month review period
20. If applicant (or spouse) sold or transferred property within the last 60 months provide proof of value at time of sale/transfer, closing statement of sale/transfer
21. Proof of health insurance, proof of last premium paid and letter of credible coverage for prescription plans
22. Letter verifying Medicare cut off dates, health insurance payments and cut off dates and private payments made to the nursing home if applicable
23. Bills showing any current outstanding medical bills including nursing charges
24. Armed services home discharge papers or proof of military service for applicant/spouse
WHAT IS A 'LOOKBACK' PERIOD?
When applying for Medicaid for nursing facility services (nursing home), the local department of social services will look at financial transactions to determine whether any assets have been transferred or given away for less than fair market value during a certain time period prior to your application in order to determine if a transfer of assets penalty period needs to be applied. This is known as the "lookback" period. Currently the "lookback" period is 60 months (5 years) prior to the month you are applying for coverage of nursing home care.
A penalty period may be imposed for the transfer of non-exempt assets for less than fair market value. The penalty period results in a period of ineligibility for Medicaid coverage of nursing facility services. A penalty period is not applied for the transfer of your home to the following individuals:
Child under the age of 21
Sibling who has an equity interest in the home and has resided in the home for at least one year immediately prior to you entering the nursing home.
Adult child who resided in the home for at least two years immediately prior to you entering the nursing home and who provided care to you which permitted you to reside at home rather than in a medical facility.
For more information regarding the transfer of assets and penalty periods, please contact your local department of social services.
WHAT IS A LIFE ESTATE?
A life estate is limited interest in real property. A life estate holder does not have full title to the property, but has the use of the property for his or her lifetime, or for a specified period. The life estate is not considered a countable resource, and no lien may be placed on it.
If you or your spouse sell the life estate interest for less than fair market value, it can be considered a transfer of assets and may be subject to the penalty period.
AM I ALLOWED TO HAVE A PREPAID BURIAL FUND?
You may establish an irrevocable pre-need funeral agreement with a funeral firm, funeral director, undertaker or any other person, firm or corporation which can create such an agreement for your funeral and burial expenses. Pre-need burial agreements purchased for certain members of your family on or after Jan. 1, 2011, must also be irrevocable. The pre-need funeral agreement is used towards burial and funeral expenses and is not counted as a resource when determining Medicaid eligibility.
If you (your spouse) do not have an irrevocable pre-need funeral agreement or if the irrevocable pre-need agreement has less than $1,500 designated for non-burial space items, you may be allowed to have money set aside in a burial fund. The limit for single individuals is $1,500 or $3,000 for a couple. Please note, these funds must be kept separate from any non-burial fund related resources.
WHAT IS A COMMUNITY SPOUSE?
A community spouse is someone whose husband/wife is currently institutionalized or living in a nursing home. The community spouse is not currently living in a nursing home and usually resides at the couple's home.
I AM A COMMUNITY SPOUSE - WILL I BE ALLOWED TO KEEP ANY INCOME/ RESOURCES?
If your spouse is institutionalized or living in a nursing home, you will be permitted to keep some income known as a minimum monthly maintenance needs allowance (MMMNA). If you are currently receiving income in excess of the minimum monthly maintenance needs allowance, you may be asked to contribute 25 percent of the excess income to the cost of care for the institution.
Should you have further questions or would like to apply - please contact the Chautauqua County Department of Social Services at 661-8147. This article provided by Carmen Hlosta, director of certification/MA/CCDSS.
NY Connects is your one-stop call for information about services available to you in Chautauqua County. Call with your questions and we will provide you with local services and resources in an effort to meet your needs. You can reach NY Connects at 661-7582, Jamestown; 363-4582, Dunkirk/Fredonia; or 753-4582, Mayville; or by fax at 753-4844 or email at firstname.lastname@example.org. Its offices are located at 7 N. Erie St. in Mayville. NY Connects is brought to you in cooperation from the Chautauqua County Office for the Aging and the Chautauqua County Department of Social Services.