A recent AARP survey found that 87 percent of adults age 65 and older wish to remain at home as they age. When physical and cognitive limitations reach a certain point, however, the need for outside care often becomes a reality. Westchester elder law attorney Anthony Enea recently shed light on the Medicaid home care program in New York, including benefits and eligibility requirements.
“For seniors in the southern tier of New York in need of assistance with the activities of daily living, the Medicaid home care program is both easily accessible and relatively generous,” said Enea, who has spent 30 years protecting the rights of seniors, the disabled and their families. “One of the first questions I’m asked is often whether the transfer of asset rules apply for Medicaid home care. Many are relieved to learn that they don’t.”
In New York State, an unmarried person may transfer non-IRA/retirement assets in excess of $15,150 to a recipient (or recipients) of their choice and/or to an irrevocable trust and still be eligible for Medicaid home care. While IRAs, 401Ks and other qualified accounts are not considered available resources for Medicaid eligibility, the required minimum distributions from these accounts are counted as available income.
The spousal impoverishment rules are also applicable for Medicaid home care. A married applicant may transfer non-IRA/retirement assets in excess of $15,150 to his or her spouse, who can then execute a spousal refusal letter. This letter advises Medicaid not look at the spouse’s assets and/or income when determining eligibility. Once the transfers are made, the applicant would have $15,150 or less in his or her non-IRA assets, thus making him or her eligible for Medicaid from the resource (assets/savings) perspective.
“The execution of a spousal refusal letter does allow Medicaid to sue the refusing spouse for the value of the services they have provided,” noted Enea. “However, in light of the exorbitant private pay cost versus the Medicaid reimbursement rate – and the fact that there is uncertainty as to whether Medicaid will pursue a spousal refusal claim – the execution of spousal refusal is often the most logical option.”
Another factor that makes the Medicaid home care program accessible is that seniors can still retain virtually all of their income to pay for living expenses. Medicaid allows a recipient to keep the first $862 of his or her income and contribute all income above that amount to a pooled community trust (administered by a charity) to pay bills.
The number of home care hours an applicant will receive depends on the extent to which he or she can perform the activities of daily living. Around-the-clock care is possible, although more common is eight to 12 hours per day, seven days per week.
“While it sounds unbelievable that one could transfer his or her assets, protect their income and still be eligible for Medicaid home care in New York, it is currently a reality,” said Enea. “Whether New York Medicaid will be able to sustain its largesse remains to be seen, however – especially if changes are made to the program federally.”
Enea, Scanlan & Sirignano, LLP, is located at 245 Main St., White Plains, with additional offices in Somers. Elder law attorney Anthony Enea can be reached at 914-948-1500 or a.enea@esslawfirm.com. For the latest news, visit Enea, Scanlan & Sirignano online at www.esslawfirm.com.
