With life comes many unexpected challenges. As we age, the need for long-term care may come suddenly, leaving you or your loved one without a plan. Fortunately, Medicaid can provide the elderly with community-based health coverage that Medicare and private insurance don’t cover. The program is a health insurance plan for those who otherwise cannot afford health provider services and related medical care and supplies.
For seniors over the age of 65 years, Medicaid is an important resource, particularly when they need long-term care. However, some elderly may find themselves ineligible to receive Medicaid benefits due to excess income. However, with the right planning, seniors in New York can qualify for Community Medicaid.
What is community-based Medicaid in New York State?
The cost of receiving nursing-level care while staying in your home is expensive and out of reach for many. To help seniors cover this type of home care, Medicaid provides assistance through the Community-Based Medicaid program. Other coverages in this program can also include required medical supplies and certain programs that provide adult day care.
Recipients of Community Medicaid typically need assistance on a daily basis with performing basic functions called ADLs (activities of daily living). These activities include dressing, bathing, eating, toileting, and transferring (e.g., from bed to bathroom).
What benefits and services are included in Community Medicaid in NY?
Eligible recipients in New York State will receive long-term benefits and services that include doctor and medical clinic visits, x-rays, laboratory tests, adult daycare, and home and personal care aides. Other benefits include mental health services, medical drugs, physical and speech therapy, transportation to medical providers, durable medical equipment, prosthetic and orthotic appliances, and light housekeeping.
Who typically qualifies for this type of Medicaid coverage?
To qualify for Medicaid’s long-term care benefits in NY State, you must be over the age of 65, be disabled, or be certified as legally blind. Individuals with disabilities who are under the age of 65 years old may also qualify with certification by the state or Social Security. Other determining factors for Medicaid eligibility include financial and non-financial criteria as well as having a medical need.
In addition to seniors who seek to receive long-term care at home, these community-based services are also made available to persons who reside in assisted living settings and nursing homes.
What are the eligibility requirements to receive NY Community Medicaid program benefits?
Since Medicaid is a mean-based program that is jointly provided by the Federal and State governments, eligibility will require that certain criteria be met. You may qualify based on your age, disability, certain income requirements and resources, or if you are receiving SSI (Supplemental Security Income). These eligibility rules and available services vary according to various age groups and circumstances. Certain services are only made available to those who qualify for Medicaid.
New York State financial criteria is based on the Medicaid recipient’s income level and varies according to the size of the recipient’s household. Medical needs are determined by whether or not daily supervision or care is needed, daily treatment needs, and if care is needed day and night from a skilled care provider.
How can NY seniors plan to qualify for these community-based benefits?
If you find you do not meet the eligibility criteria to qualify for Community Medicaid in New York, you may benefit from getting help from KTS or an attorney versed in elderly law. The steps involved include applying, preparing the forms, and gathering up the documents, which can be a stressful and complex process.
In addition, you will need to provide verification that you have both a financial and medical need. Doing so may require spending down your excess income, reorganizing your finances, switching to pooled trusts, and obtaining required healthcare provider certifications in order to qualify.
But seeking help with a plan designed to ensure success can work toward gaining eligibility to receive Community Medicaid benefits. These covered services will allow you to stay home while getting the medical and personal care you need.
