Medicaid Has Many Levels, Eligibility Limits

Question: I heard Medicaid is changing and I might qualify.

Answer: Medicaid is a word that we see and may not understand what it is. It is true Medicaid income eligibility has increased significantly and many more individuals and couples may find themselves eligible for benefits. Please remember that I mostly work with the elderly, so I do focus on how and what it does for that age group.

Medicaid has many levels of eligibility, Slimb/QI-1 and QMB benefit are often referred to as Medicare Saving Programs (MSP). Next is what I call Community Medicaid and lastly Long Term Medicaid. All of these benefits require an application be submitted to Department Health and Human Services (DHHS), including supporting documentation.

The application(s) for the following benefits can be obtained by going to the DHHS office closest to you, Jamestown, Mayville, or Dunkirk. They can also be found on the www.mybenefits.ny.gov/ website. You can also call your local DSS office and request one be mailed to you.

In 2023 the rules regarding Medicaid eligibility have changed significantly. There has been a significant increase to the amount individuals and couples can make in income each month and have in assets.

The Medicare Savings Programs (MSP) have monthly income caps of $2107 for an individual and $2838 for a couple with no resource test. The MSP application is a smaller application with fewer documents required to be eligible. Because there is no resource test, there is no look back period for previous transactions. This benefits pay your Medicare Part B premium, Part D premium and reduce your costs for medications.

Community Medicaid allows for an individual to live in their home, apartment or assisted living facility and still receive coverage for their medical costs. Community Medicaid has an income cap of $1563 for one person or $2106 for a couple. As the household size increases the monthly income increases. I work with primarily seniors so my households generally stop at 2 people. This Medicaid benefit does have a resource test. That means you have to be below $28,133 for one person or $37,908 for two people with regard to assets. This is money in the bank, investments, bonds, life insurance, etc. If you live in your home, your home is not counted as an asset. This application also includes a 30 month review of all financial transactions.

Community Medicaid will pay for health insurance premiums (Medicare and others). It will pay for medical equipment, homecare, medical transportation services, hospital stays, dental care, vision needs and many other things. If you have other insurance (like Medicare) Medicaid would always be secondary, except for those services not covered by Medicare. An example is dental services; Medicare does not cover dental, so Medicaid would be the primary payer for dental care. Medicaid is always considered the payer of last resort.

The final Medicaid level of coverage is Long Term Medicaid which includes a five year look back period. That means in order to be determined eligible for this benefit you must document and prove five years’ worth of financial records to DHHS. I often stress keeping your financial records for at least five years and this why. This benefit would pay for care in a Nursing Home or care in your home.

For individuals Long Term Medicaid has the same income and asset test as community Medicaid

For couples this Long Term Medicaid is called Spousal Impoverishment Medicaid. Their income is divided between $50 for the Institutional Spouse (living in the nursing home) and $3435 for the Community Spouse (still living independently). The resource test is also very different; the Institutional Spouse can keep $28,133 in their name and the Community Spouse can keep the house they live in, the car they drive and up to $74,820 and in some situations more in resources/assets. This benefit allows for the community spouse to keep a higher amount of income and assets, so they can maintain successfully in the community.

I will say again, I have simplified these benefits to explain briefly in this article. I have done so to give you information to keep in mind as you look at your own life. If you have questions or need additional information, call Senior Life Matters. There are always extenuating circumstances, so some of this information could apply slightly differently to you due to your particular situation.

Senior Life Matters is a community based program sponsored by Lutheran Jamestown. For questions and concerns or to reach Janell Sluga, GCMC, call 716-720-9797 or email SLM@lutheran-jamestown.org.


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