What Is Community Medicaid In New York State

What Are The Income Limits For Community Medicaid In New York

Income limits for Community Medicaid do exist in New York. Currently these limits are $875 monthly per each individual and for couples the limit is $1284. The disabled, elderly, and/or blind applicants will be entitled to what is called a disregard of $20 on any unearned income.

This disregard means it will not be considered or budgeted. When taking this $20 disregard into account, individual income limits are $895 per month and the couples limit is at $1,304 per month. Resource limits are also in place. These limits are $23,100 for couples and for individuals is $15,750.

Early Planning Is Key To Getting Medicaid When You Need It

At Landskind & Ricaforte Law Group, P.C., we know the difference Medicaid benefits can make to people who need care as soon as possible. We guide you through all steps of the process, getting you the care you need without sacrificing your loved ones’ inheritances. Call us today at 333-5007 or contact us through our online form to learn how we can be of assistance.

Ny Medicaid Income Limits And Financial Resource Caps

The Medicaid program pays for the high costs of institutional and long-term nursing home care and for a multitude of at-home or assisted living facility services and expenses. Because of the mounting expense of healthcare services for elders, aged 65 and older, and disabled residents, eligibility for Medicaid health insurance coverage is restricted by income and asset caps, as well as look-back periods for transfers of assets.

Working with an experienced elder-law attorney at Ely J. Rosenzveig & Associates can, with the proper planning, ensure access to Medicaid coverage even for those whose income and resources exceed the Medicaid eligibility caps.

2022 Income and Resource Limits for Chronic and Community Medicaid: The eligibility rules for New York Chronic Medicaid and Community Medicaid include the following income and financial resource limits:

• Monthly Income Limits

• $1,637 for a married couple, both spouses applying for Medicaid coverage

• $934 for a married applicant where only one spouse is applying for Medicaid coverage

• $24,000 for a married couple, both spouses applying for Medicaid coverage

• $16,000 for married applicant spouse and $137,400 for non-applicant spouse

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Northwell Opens Two Multidisciplinary Practices In Suffolk County

Northwell Health Physician Partners has opened practices in Setauket and Port Jefferson, Long Island, in a project that costs more than $2 million total, the health system announced Thursday.

The Setauket office at 3 Technology Drive cost $1.8 million to open, according to Northwell, and its 6,240 square feet of space will offer internal medicine and urology services. Eight physicians and 14 additional employees will staff the clinic, Northwell said.

In Port Jefferson, a $500,000, 5,635-square-foot office at 815 Hallock Ave. will offer patients breast surgery, cardiovascular care, nephrology and neurology services, neurosurgery, obstetrics and gynecology care and plastic and reconstructive surgery. The location will employ 18 physicians and 16 staff members, Northwell said.

The practices will support continuing care for patients who receive services at nearby Mather Hospital in Port Jefferson, the health system said.

These state-of-the-art facilities allow us to bring new and expanded services to this growing community and support the strategic growth at Mather Hospital, Joseph Baglio, senior vice president and ambulatory operations officer for Northwell Healths Eastern region, said in a news release.

Northwell recently opened a more than 25,000-square-foot facility in Bay Shore.

Medicaid Alert: New Medicaid Community Care Look Back Rules Start October 1 2022

If this sounds familiar, youre rightrecent years have seen many extensions of rules regarding Medicaid. But for New Yorkers, this most recent change to Medicaid Community Based Care is a result of a New York States 2022-2023 budget and not the pandemic.

There has always been a five-year lookback period for Medicaid applicants seeking coverage for long-term nursing home care. Any transfer or sale of assets within a five year makes an applicant ineligible and nursing home costs have to be paid by the person or the family until the person spends down enough of their assets to become eligible.

The look-back is now being applied to Medicaid Community or Home Care. This is a first for New York State, and it requires seniors to do advance planning if they wish to receive Medicaid Community and Home Care services and protect their assets.

After October 1, 2022, anyone applying for Medicaid Home Care benefits will be subject to at least a 15-month lookback. Its also possible the person and their spouses will have to provide records of up to 2.5 years before the application date.

The lookback period is not as long as for long-term nursing care, but this will still have a negative impact on those who need Medicaid Home Care.

We cant stress this enough: As of right now, there is NO look-back or penalty period for Medicaid Home Care benefits. This includes home health aides, adult day care and community based services.

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How Has The 20

Until now, a look back period only applied to Chronic Medicaid for nursing home or institutional care. However, the new budget has imposed a 30 month look back period for individuals applying for Community Medicaid where previously there was none. This change takes effect on October 1, 2020.Certain transfers will remain exempt. Most notably, exempt transfers will continue to include transfers to a spouse, a disabled or blind child, or a trust for the sole benefit of such a child, or to a trust established solely for the benefit of an individual under sixty-five years of age who is disabled.

Are You Already Getting Insurance Through Your Employer

If you have health insurance coverage through your employer, you should keep that insurance and reach out to HRA. Medicaid may cover the cost of the premium for that insurance coverage.

The MBI-WPD program does not offer family coverage. Single people and married couples are both covered under this program if both individuals are working and have a disability. Spouses without a disability and children may be covered through other programs such as Medicaid through New York State of Health or Child Health Plus.

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What Can Medicaid Applicants Expect After This New Law Goes Into Effect

NY Medicaid applicants may not be eligible for home care or community services if they transferred assets within the lookback period. These applicants will be required to disclose all financial records during that time.

Any transfer of assets during the months preceding the affected Medicaid applications will signal a review. During that time, if any assets are transferred to others lower than fair value, a transfer penalty will be incurred.

With this in mind, it may be time to reevaluate your situation or that of a loved one. Are you or a loved one planning to file a Medicaid application to receive home care services? If so, it may be wise to do so prior to the laws start date.

When Do You Have To Present Your Card

You will need to present your Medicaid Benefit Identification Card after any health-related appointment or when you go to pick up a prescription medication. There are certain restrictions around what is covered by Medicaid and what is not, however, because many healthcare costs are covered by Medicaid, recipients will be asked to present their card at most healthcare institutions. Although sometimes coverage may not be provided, Medicaid cards should be presented any time you use any medical service in New York.

Your Medicaid coverage and card entitles you to receive coverage for a wide array of medical services, including :

Doctors visits

Prenatal and postnatal care for pregnant women

Some medical equipment costs

Therapy, counseling, and psychiatric care

Nursing home care for the elderly

Dental care

Home health care and personal care

And more

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Long Term Care Options

• Personal Care : Home Attendant and Housekeeping services for individuals having difficulty with at least one or more activities of daily life. Individuals must be Medicaid eligible and otherwise exempt from Managed Long-Term Care or Managed Care. In addition to Personal Care services, there is also a Consumer Directed Personal Assistance Program.
• Managed Long-Term Care Program: Covers case management, nursing, home health aides, home attendant services, physical therapists for people who are Medicaid eligible, or eligible for both Medicaid and Medicare, and are medically eligible for long term care services. More information from the NYS Department of Health.
• Assisted Living Program: Long term residential care, find more information on this state administered program.
• Long Term Home Health Care Program: Plan of medical, nursing and rehabilitative care provided at home to persons medically eligible for placement in a nursing home. These individuals must have care costs which are less than the nursing home cost in the local county. Individuals can access this program through a hospital discharge planner, HCSP, or a Long Term Home Health Care Provider.

HRA’s Office of Special Services oversees the Home Care Services Program. For assistance, please call Infoline at 718-557-1399 or visit your local Home Care CASA Office.For more information on Customized Assistance Services, please visit CUCS.org.

Institution For Mental Disease In Lieu Of Service Benefit

Institution for Mental Disease In Lieu of Service Benefit information

• PDF 39.88KB Last Updated: 11/12/2020

Notice:

New York State Department of Health has stated Medicaid recipients should receive breast cancer surgery services at high volume facilities .

See the listing of low-volume facilities that will not be reimbursed for breast cancer surgeries provided to Medicaid recipients.

This policy does not affect a facilitys ability to provide diagnostic or excisional biopsies, and postsurgical care for Medicaid patients.

Clinical Practice Guidelines

UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for preventive health and other health conditions.

View the entire list of guidelines or call our Member Services at 1-800-493-4647 to request a printed copy.

• PDF 2.36MB Last Updated: 10/13/2021

Summer

• PDF 1.97MB Last Updated: 07/06/2021

Spring

• PDF 6.45MB Last Updated: 03/18/2021

Winter

• PDF 7.17MB Last Updated: 01/05/2021

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New York Medicaid Office

Below is the contact information for the Medicaid office in New York. They can assist you with questions or concerns about the New York Medicaid program, including the eligibility requirements and Medicaid enrollment in New York. You can view their site online at omig.ny.gov. To find out if you are eligible for this program, New York Medicaid eligibility.

The Medicaid program in New York covers basic medical care. This may include doctor services, inpatient hospital care, laboratory and x-ray services, inpatient short-term skilled nursing or rehabilitation-facility care, outpatient hospital or clinic care, short-term home healthcare, ambulance service and prescription drugs for people not covered by Medicare. We suggest contacting the Medicaid office to find out specifically what coverage is provided as it can be different in each state.

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What Is A Look Back Period

A “look back” period for Medicaid means that from the date of an individual’s application, Medicaid will “look back” at all transfers of assets by the applicant made within the preceding period of specified length. Any gifts or transfers made for less than fair market value can make the applicant ineligible to receive benefits for a determined penalty period.Currently, Community Medicaid has no look back period. Chronic or Nursing Home Medicaid has a look back period of 5 years . With no look back period, an individual in need of services at home could gift or transfer their assets to someone else or a trust, thereby meeting the income and asset requirements to become eligible for Community Medicaid benefits the month after the transfers were made.

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New York State Passes New Law To Qualify For Community

On April 3, 2020, New York State passed the 2020/2021 Budget, which contains a number of changes for New York residents. Among those, one of the most significant changes impacts the way New Yorkers qualify for Community Medicaid benefits. These changes have been codified in amendments to Social Services Law Section 366. Below we have summarized the new law for you in the form of a Q & A.

How Do I Find The Services Of The Assisted Living Program

Private-payers and Medicaid recipients may contact the ALP directly. However, Medicaid recipients must have their ALP services approved in advance by the Local Social Services District.

ALPS are regulated by the State Department of Health. The regulations require that the appropriateness of ALP services be determined by initial and periodic reassessments provided by the ALP. ALP operators are required to provide sufficient staff to perform case management functions for assisted living residents and to ensure their health, safety and well-being. ALPS are required to provide a staffing plan for review by the Department. ALPS also must meet prescribed environmental standards, which include standards for the installation of fire prevention systems and the space provided for administrative activities.

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What Are The Eligibility Requirements For Community Medicaid In New York

Since Community Medicaid is a means-tested program, there are specific requirements that must be met in order to qualify for benefits. Firstly, an individual must be aged 65 or older or disabled. There must also be an established need for services. Prior to 2021, an applicant needed to show that they need assistance with at least two activities of daily living .

As of July 1, 2021, applicants must show a need for assistance with a minimum of three ADLs. If the individual has an Alzheimers or dementia diagnosis, the applicant needs to show they need help with more than one ADL. These ADLs include:

• Bed mobility turn and position

There are also personal care tasks that may be factored in when determining eligibility. Examples of Level II personal care tasks include:

• Administration of medications
• Preparation of meals with modified diets
• Providing routine skincare
• Changing of simple dressings

Also, recipients need to be financially eligible. In order to determine someones eligibility, there is an assessment of the applicants income as well as assets. The state will review two categories within the applicants financials including their income and applicable resources.

In this case, income is considered as any monies generated regardless of the source. This income can include Social Security, wages, pensions, alimony, IRA in distribution, or gifts.

Do I Have To Reapply For Medicaid Every Year

Yes, you will have to reapply for Medicaid every year. However, unless your financial or life situation has changed, the renewal application process is usually significantly simpler and takes less time than the initial Medicaid application. Because Medicaid is a government funded health insurance program with strict rules regarding who is eligible and who is not, itâs important that all recipients reapply on a yearly basis to alert authorities to changes in their financial situation. Thus, each year, you will have to review whether or not you are eligible and, if you are eligible, youâll have to provide all the necessary documentation to reapply for Medicaid.

Most Medicaid recipients receive a packet in the mail each year with all the information they need to be able to re-enroll in the Medicaid program and obtain a new CBIC card. If you no longer qualify for Medicaid, you will receive a rejection letter in the mail informing you that you are no longer eligible and will not be receiving a new Medicaid card and coverage for the coming year. Always remember to keep your current address updated with the Medicaid office because Medicaid will only send mail to the address on file. Medicaid documents cannot be forwarded to a new address. So, if you move to a new house or apartment, make sure to update your address so that you will receive the documents you need to reapply in the coming year.

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Medicaid Offers A Full Range Of Health Services For Eligible Persons Including:

• All regular medical checkups and needed follow-up care.
• Medical equipment and appliances .
• Lab tests and x-rays.
• Eye care and eye glasses.
• Emergency care.
• Emergency ambulance transportation to a hospital.
• Hospital stays.

For some pregnant women, services may be limited to perinatal care if their incomes are too high to qualify for full Medicaid coverage.

For children birth to 21 years old, Medicaid offers the Child/Teen Health Program , which provides the services listed above for all Medicaid recipients. C/THP places an emphasis on preventive care and treatment. For example, Medicaid requires that all children be screened with a blood lead test at one and two years of age. C/THP is available from fee-for-service healthcare providers. Also, all managed care plans must offer C/THP to Medicaid recipients under 21 years of age who are enrolled in their plan.

Child Health Plus and Family Health Plus provide services to eligible children and adults, respectively, through managed care plans.

How Can You Apply

You or your authorized representative can apply by mailing in an application to the address below:

Initial Eligibility Unit HRA/Medical Assistance Program PO Box 24390 Brooklyn, NY 11202-9814

You can also fax your application to 917-639-0732. Your authorized representative can fax an application to 917-639-0731.

You or your authorized representative can also apply at any local Medicaid office within New York City. You can call 311 for the nearest Medicaid Office, or visit our Medicaid Office page for the complete list.

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