Medicaid is a joint federal, state and city programme which provides medical assistance or insurance for persons with low incomes and limited assets. It is available to persons who are eligible for public assistance or SSI (Supplementary Security Income). However, the rules applying to Medicaid vary from State to State as regards those who are eligible to apply. In New York, the Medicaid Surplus Income Program is available for persons over sixty - five or who are blind or disabled whose incomes are too high to qualify for public assistance or SSI, but who spend down any excess income on medical costs until they reach the Medicaid income level.
The following are answers to commonly asked questions about this scheme:
1. Is Medicaid means tested in the Unites States?
There are a number of financial thresholds set on an individual before applying including rules governing the transfer of assets. In New York State, transfers of resources (gifts) will not disqualify one from receiving community - based care including home health care, but will cause a disqualification period for nursing home care.
2. What are the income / asset thresholds within which one needs to operate?
Medicaid:
As discussed above, transfer of gifts will not disqualify one from receiving community - based care for Medicaid. Pursuant to the Deficit Reduction Act 2005, the transfer of assets rules are changed as follows:
a). A five year look back is created.
b) A penalty or waiting period from when a person is receiving institutional care and would be otherwise eligible is calculated.
c) Limits on Home Equity are created.
d) The State is required to be the beneficiary on annuities.
Under the transfer rules, certain resources and transfers are exempt for example in our clients case, the transfer of land from husband to wife is exempt if the resource was transferred to a spouse or to another for the sole benefit of the spouse. Also, if the resource was intended to be disposed of at fair market value or the transfer was exclusively for a purpose other than to qualify for Medicaid. The law states that Medicaid also would not be denied if it would work an undue hardship. This concept however may be difficult to establish.
3. Is the Principal place of residence taken into account?
A home is exempt if transferred to a Spouse, a minor (under 21), or a blind or disabled child of the person, a brother / sister with an equity interest in the home who resided in home one year before institutionalisation and a son / daughter who resided in the home two years and provided care so as to keep the person from becoming institutionalised. The transfer is exempt if the resource was transferred to a spouse or to another for the sole benefit of the spouse.
4. Is Property outside the United States taken into Account?
All income is taken into consideration when calculating Medicaid:
Medicaid is available only to people with limited income. The chart below shows how much income you can receive in a month and the amount of resources you can retain and still qualify for Medicaid. The income and resource levels depend on the number of your family members who live with you.
2007 Income & Resource Levels*
Number in Family - Monthly Net Income - Resources
1 - $700 - $4200
2 - $900 - $5400
3 - $1100 - $6600
4 - $1109 - $6650
5 - $1117 - $6700
6 - $1134 - $6800
7 - $1275 - $7650
8 - $1417 - $8500
For each additional person, add: $142 - $850
Income and Resource Levels are subject to yearly adjustments.
You may also own a home, a car, and personal property and still be eligible. The income and resources of legally responsible relatives in the household will also be counted. Note that Medicaid may recover the amount of the cost of these services from the assets in our clients' estate upon her death.
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