Past Paid Medical Bills
Past paid medical bills may be used if the medical services were provided and paid for within the three calendar months before the month you applied for Medicaid with excess income. They may be applied to meet your excess income for up to six months beginning in the month you applied, and sometimes beginning up to three months before you applied, if you want “retroactive coverage” for Medicaid to pay your recent medical bills.
Bills paid by EPIC or ADAP in the three months before the month in which you applied for Medicaid may be used to meet your excess income.
- Example 1: You paid your 17-year old child’s dental bill in June for dental care provided in May. You have your own unpaid medical bills in the months of June and July. You apply for Medicaid in August. You may use the paid dental bill toward your excess income beginning in the month of June.
- Example 2: Each month EPIC has been paying $100 for your prescriptions and you have been paying your $20 co-payment. In October you apply for Medicaid. You have no unpaid medical bills. You are determined eligible for Medicaid and your case is opened effective October 1 with a $50 monthly excess income. Since you do not need coverage in the three month retroactive period , the paid amount of $360 can be used to meet your excess income for six months . The $60 balance will be lost as paid bills can only be used up to a maximum of six months.
Where Can Medicare Beneficiaries Get Help In New York
New York Health Insurance Information Counseling and Assistance Program
You can access no cost Medicare counseling by contacting the New York Health Insurance Information Counseling and Assistance Program at 1-800-701-0501.
HIICAP can help you enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. HIICAP counselors may also be able to suggest local home care or long-term care agencies. This website has more information about the services HIICAP offers.
Elder Law Attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. You can use this search feature on the National Academy of Elder Law Attorneys website to find an elder attorney near you.
Your Guide To Understanding Medicaid Spend
Understanding how insurance works is difficult for the majority of the population. If you are a senior who is eligible for or who recently enrolled in Medicaid, you may have questions about what you are responsible for paying yourself. Medicaid Spend-Down is a term that is frequently talked about related to Medicaid. But what does it actually mean and how does it impact the coverage a senior receives? This article explains what Medicaid spend-down is, how it works, and what it covers.
Qualifying for Medicaid
For a senior to qualify to receive Medicaid, they must have assets that total less than $15,750 as an individual or $23,100 as a couple per year, have high health costs, and be over the age of 65. Assets counted for Medicaid eligibility include:
- Checking Accounts
A senior can meet the age requirements, have high health costs, have combined assets $15,750 or $23,100 as a couple, and still need Medicaid. This is where the Medicaid Spend-Down Program comes in.
Not everyone who has Medicaid can qualify for the spend-down program. People who do qualify must:
- Be an Adult age 65 or older
- Disabled or Blind
- A Child Under 21
What is the Medicaid Spend-Down Program?
- An individual seniors assets are $500 more than the individual limit. If they have medical bills that are more than $500 each month, the amount after that $500 will be covered by Medicaid in New York.
What Expenses Qualify for Spend-Down in the Program?
How Does the Spend-Down Work?
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Medicaid Recipients Have A Little More Time To Spend Down Their Stimulus Money
The one-year deadline for nursing home residents on Medicaid to spend down their first round of stimulus checks is here, but they may have a little extra time.
In March 2020, the Coronavirus Aid, Relief, and Economic Security Act authorized $1,200 stimulus checks to most Americans, including Medicaid recipients. Another round of $600 checks was authorized in December 2020, and $1,400 checks were ordered in February 2021. The stimulus checks are not considered income for Medicaid recipients, and the payments have been excluded from Medicaids strict resource limits for 12 months.
While the one-year deadline for spending down the first round of checks is here, another COVID-19 bill gives beneficiaries more time. The Families First Coronavirus Response Act passed in March 2020 provides that if you were enrolled in Medicaid as of March 18, 2020, the state cannot terminate a recipients benefits even if there is a change in circumstances that would normally cause the benefits to be stopped. The law states that the recipients Medicaid coverage must continue through the end of the month in which the Secretary of Health and Human Services declares that the public health emergency has ended. The public health emergency is set to end April 20, 2021, but it will likely be extended.
If Youre Married But Only One Partner Is Applying For Medicaid
Nursing home – $5,750 for the partner who is applying for Medicaid. The spouse not applying for Medicaid can have assets up to $128,640.
Home care / daily activities – $5,750 for the partner who is applying for Medicaid. The spouse not applying for Medicaid can have assets up to $128,640.
Regular Medicaid – $23,100
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Spending Down Assets To Qualify For Medicaid
When it comes to Medicaid, whether in the state of New York or elsewhere in the country, there is usually a limit on the assets you can own to qualify for Medicaid.
But just like income limits, you can spend down assets on qualified expenses to meet the requirements for Medicaid.
For example, if you prepay for funeral services, youâre taking part of your cash assets and spending it towards a service that qualifies for asset spend down. Now, youâve reduced the value of your assets, and youâre closer to meeting the limits for Medicaid.
Before we delve into all of the specific ways you can spend down assets, letâs first examine the asset limits in New York to qualify for Medicaid.
If you donât live in New York, then you should check with your stateâs Medicaid agencies for the asset limits. But the general idea of spending down assets will be the same.
Funeral And Burial Expenses
Most states will allow for the pre-payment of certain funeral and burial expenses. This can be a complicated issue, however, since individual states have their own rules about what can be purchased and how much can be invested in these expenses. Check with your individual state Medicaid program or an estate planning or elder law attorneyfor detailed information.
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What Is Considered Excess Income For Medicaid Qualification
In the example above, we illustrated a simple situation to demonstrate how a spend down might work.
But in reality, it is a bit more complex than that, and your Medicaid caseworker will help you determine the exact amount that is in excess of what you need to qualify for Medicaid.
Your caseworker will take your monthly income, and make certain deductions to calculate your countable income for Medicaid purposes. Your excess income is only the difference between this countable income and Medicaid limit .
Your deductions will also vary based on your qualifying criteria for the excess income program. For example, your deductions will be different if you qualify through disability than if youâre eligible because youâre pregnant.
Where Can I Apply For Medicaid In New York
Medicaid eligibility is overseen by the Human Resources Administration in New York City and by Local Departments of Social Services elsewhere in the state. You can apply for Medicaid for the aged, blind and disabled or an MSP at an HRA office or at your LDSS .
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked with hospital, insurer and technology clients.
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Calculating The Spend Down Amount
While one may know its necessary to spend-down some of their countable assets to qualify for Medicaid, the exact amount that needs to be spent down may be unclear. This is because the asset limit varies by state, as well as if one is single or married, and if married, if one or both spouses are applying for Medicaid. While the preceding factors are relatively simple to calculate, states also vary in the way they calculate the amount of countable assets a healthy spouse can keep. This adds to the complexity of the calculation.
IndividualsThe asset limit for a single elderly individual for long-term care is $2,000 in most states. However, there are some exceptions. For example, as of 2020, the asset limit for a single individual in Connecticut is $1,600, in Nebraska it is $4,000, and in Minnesota it is $3,000.
When a couple is married, all assets are considered joint assets. Learn more about joint assets here. In most states, the asset limit for a couple where both spouses are applying for Medicaid is $3,000. Again, there are exceptions to this rule. For instance, in 2020, the asset limit in this situation for long-term care is $4,000 in Arizona, $6,000 in North Dakota, and $23,100 in New York.
2020 Medicaid Community Spouse Resource Allowance
|Couples Combined Assets|
Home Care Medicaid Lookback Examines Transfers Back To October 2020
The implementation of the new lookback period has been rescheduled several times due to the 2020 COVID-19 pandemic. Currently, the new NY Medicaid transfer rules will begin on January 1, 2022. After this date, any person applying for Medicaid home care benefits will be subject to at least a 15-month lookback, and could possibly have to provide records up to 2.5 years prior to the date of application.
Heres what you need to know about the new transfer rules:
- Applicants and their spouses filing after January 2022 will need to provide all financial records within the lookback time frame, even if spouses do not currently need Medicaid services.
- Any asset that has been sold, given away, or transferred below a fair market value during the lookback period may result in a period of ineligibility for Medicaid benefits. The cash value of the transfers will determine the number of months Medicaid will deny payment for home- or community-based care.
- The lookback period will eventually increase to 30 months. After January 2022, an additional month will be added until the period for asset transfer records reaches 2.5 years in April 2023.
- Applicants who file their Medicaid applications before January 1, 2022, will NOT be subject to this lookback and will NOT incur transfer penalties. Early filing is key to getting the benefits you need for home care services. Schedule a free consultation today to discuss how we can assist you before and after the new law takes effect.
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Medicaid Lookback Period Has Been Pushed To January 2022
All states have a five-year lookback period on applications seeking Medicaid for nursing home care. However, the State of New York recently adopted a law imposing a lookback period for long-term home care as well. While the lookback period for home care isnt as long, it can still negatively impact people who need Medicaid benefits sooner rather than later.
Understanding The Medicaid Spenddown
What is a Medicaid spenddown?
It is a way of becoming eligible for Medicaid despite having too much income to be financially eligible. The amount of income a person or family has over the Medicaid financial eligibility guidelines is called excess income. Some people may qualify for Medicaid if they spend the excess income on medical bills. This is called a spenddown.
For example, a person over 65 is denied Medicaid because her monthly income is $50 more than the limit for Medicaid eligibility. If she spends $50 per month on medical bills, the rest of her medical bills will be covered by Medicaid. The spenddown in this case is the $50 she spends on medical bills.
If your monthly medical expenses usually are more than the maximum income level to qualify for Medicaid, it may be more convenient for you to send a check each month to the Department of Social Services for the amount you have to spend down. Your Medicaid coverage is sure to continue if you do this. Ask your worker about this.
Who qualifies for a spenddown?To qualify you must be in one of the groups listed below:
What medical bills can be counted towards a spenddown?
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Who Is Eligible For The Medicaid Spend Down Program In New York
To be eligible for a Medicaid spend down in New York, you must meet the following requirements.
- Youâre under the age of 21
- Or, youâre 65 years of age or older
- Youâre certified blind
- Youâre pregnant
- Youâre the parent of a child under the age of 21
If you fall under any of these categories, then you might be eligible for Medicaid through the excess income program even if your income is too high.
How An Irrevocable Family Trust Relates To Medicaid Spend Down In Ny
With a properly designed Irrevocable Family Trust, assets can be transferred to your Trust while you are healthy. After 5 years have elapsed, your Trust assets will be protected. The Trust can then make gifts to your family members after this 5 year period has passed even if you are no longer in good health. A Trust can be a good vehicle to preserve your gift giving options for your family for the remainder of your life.
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What Are Countable Assets For Medicaid Eligibility
Here are some of the most common countable assets. If you own an asset that isnât listed here, or in the exempt list below, please contact your county Medicaid agency to ask if it would count.
- Cash assets
- Bank accounts – savings and checking
- Property excluding primary residence
- Retirement accounts
If you hold IRAs, 401Ks, or other investment accounts with deferred taxes, they might count as income instead of assets, as long as youâre receiving the required minimum distribution . Consult with your Medicare caseworker to determine if your 401Ks, etc. count as income or assets.
Either way, whether they are income or assets you can spend them down. We already explained how to spend down income, and weâll discuss how to do the same with assets below.
Can I Make Gifts To My Grandchildren
This edition of the Koldin Report E-Newsletter reviews whether grandparents can make gifts to their grandchildren. The previous edition of the Koldin Report E-Newsletter explained the Medicaid transfer penalty rules. The next logical question is if there are penalties for making transfers, does that mean you can no longer make gifts? All previous newsletters can be found on our website by .
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Hire A Friend Or Family Member To Provide Care
If you need assistance with activities of daily living due to a disability or chronic illness, then you can hire a friend or family member to provide care services.
This is a great way for you to continue living at home, maintain your independence, as well as providing income to a close friend or relative who could benefit from it. And it reduces your assets so you can qualify for Medicaid.
One thing to note is that for caregiving services, you must pay reasonable wages for the area where you live, even if it is a family member.
If you like the idea of having a relative or friend as caregiver, and want to continue it once you do qualify for Medicaid, check out CDPAP if you live in New York.
CDPAP is a New York Medicaid program that allows you to hire friends and relatives for home care. For detailed information, check out our guide on CDPAP.
Whats Spend Down Medicaid
Monthly spend-down amount, you can get medicaid coverage for three consecutive months. steps for using the spend-down 1. calculate your spend-down. remember, your spend-down is the difference between your monthly income and the medicaid monthly income limit . 2. decide how you will reach your spend-down. In most states, the asset limit for a couple where both spouses are applying for medicaid is $3,000. again, there are exceptions to this rule. for instance, in . However, one must know the allowable medicaid spend down items and they must proceed with caution in order to avoid violating medicaids look-back period, which is 60-months in nearly every state. (california has a 30-month look-back period and new york is in the process of implementing a 30-month look back period for long-term home and.
For a single elderly or disabled person in new york state in 2021, the income limit is $904/mo. of income. , people age 18-21 and their parents, grandparents or other “caretaker relatives” living with them are in box 1 on the hra medicaid chart). If you have a spend-down and can’t submit your bills or payment due to the covid-19 emergency, please call the hra surplus helpline at 221-0835, .
This program allows you to deduct certain medical expenses from your income so that you can qualify for abd medicaid. if you have medical expenses that .
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