New York Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: January 19, 2023

 

New York Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income persons of all ages. While there are numerous eligibility groups, including pregnant women, children, and disabled individuals, this page focuses on long-term care Medicaid eligibility for New Yorkers aged 65 and over. In addition to nursing home care, NY Medicaid pays for non-medical services and supports to help frail seniors remain living at home or in the community. There are three categories of Medicaid long-term care programs for which New York seniors may be eligible.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; anyone who is eligible will receive assistance. Care is provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; there are a limited number of participant slots and waiting lists may exist. Intended to delay nursing home admissions, services are provided at home, the home of a loved one, adult day care, or in assisted living.

3) Regular Medicaid / Disabled, Aged 65+ or Blind (DAB) – This is an entitlement program; anyone who is eligible will receive assistance. Various long-term care services, such as personal care assistance or adult day care, may be available.

Medicaid in New York is sometimes called Medicaid Managed Care. Medicaid for the Disabled, Aged 65+ or Blind (DAB) is also called NON-MAGI (Modified Adjusted Gross Income) Medicaid. NY Medicaid, which is state and federally funded, is administered by the state under federally set parameters.

  The American Council on Aging now offers a free, quick and easy Medicaid Eligibility Test for seniors.

 

Income & Asset Limits for Eligibility

Each of the 3 categories of Medicaid long-term care programs have varying functional and financial eligibility requirements. Financial eligibility criteria change annually, vary depending on marital status, and is further complicated by the fact that New York offers alternative pathways towards eligibility.

 Simplified Eligibility Criteria: Single Applicant for Nursing Home Care
NY seniors must be financially and medically eligible for long-term care Medicaid. One must have limited income and limited assets, and a medical need for care. A single individual applying for Nursing Home Medicaid in 2023 in New York must meet the following criteria: 1) Have income under $1,677 / month 2) Have assets under $30,180 3) Require the level of care provided in a nursing home facility.

The following table provides a quick reference to allow seniors to determine if they might be immediately eligible for long-term care from a New York Medicaid program. Alternatively, it may be helpful to take the Medicaid Eligibility Test. IMPORTANT: Not meeting all of the requirements does not mean one is ineligible for Medicaid or cannot become eligible. More.

2023 New York Medicaid Long Term Care Eligibility for Seniors
Type of Medicaid Single Married (both spouses applying) Married (one spouse applying)
Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required Income Limit Asset Limit Level of Care Required
Institutional / Nursing Home Medicaid $1,677 / month* $30,180 Nursing Home $2,268 / month* $40,820 Nursing Home $1,677 / month for the applicant* $30,188 for applicant & $148,620 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $1,677 / month† $30,180 Nursing Home $2,268 / month† $40,820 Nursing Home $1,677 / month for the applicant† $30,188 for applicant & $148,620 for non-applicant Nursing Home
Regular Medicaid / Aged Blind and Disabled $1,677 / month $30,180 Help with ADLs $2,268 / month $40,820 Help with ADLs $2,268 / month $40,820 Help with ADLs
*All of a recipient’s monthly income, with the exception of a Personal Needs Allowance of $50 / month, Medicare premiums, and a Monthly Maintenance Needs Allowance for a non-applicant spouse (if applicable), must go towards nursing home costs.

†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.

 

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all sources of income are counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pensions, Social Security Disability Income, Social Security Income, gifts, annuity payments, and IRA distributions. Holocaust restitution payments do not count as income.

Treatment of Income for a Couple
When only one spouse of a married couple applies for Nursing Home Medicaid or a HCBS Waiver, the non-applicant spouse’s income is disregarded. Furthermore, the non-applicant spouse, also called a community spouse, is entitled to a minimum amount of monthly income to prevent spousal impoverishment. This is called a Monthly Maintenance Needs Allowance and in NY, it is specifically called a Community Spouse Monthly Income Allowance (CSMIA).

The CSMIA allows an applicant spouse to supplement their spouse’s income by transferring some, or in some cases, all of their income to their spouse. In 2023, the CSMIA is $3,715.50. If the non-applicant spouse has monthly income under this amount, they can receive income from their applicant spouse to bring their monthly income up to this amount. If the non-applicant spouse already has a monthly income of $3,715.50 or more, they will not receive a CSMIA. Medicaid will also request that 25% of the “excess” income (over $3,715.50 / month) go towards the applicant spouse’s care costs. An applicant spouse in this situation can institute Spousal Refusal.

Income is counted differently when only one spouse applies for Regular Medicaid / Disabled, Aged 65+ or Blind; the income of both the applicant and non-applicant spouse is calculated towards the applicant’s income eligibility. Furthermore, there is no Community Spouse Monthly Income Allowance for a non-applicant spouse. More on how Medicaid counts income.

 

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable assets (often called resources) are calculated towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, vacation homes, bank accounts (checking, savings, money market), and any remaining funds from Covid-19 stimulus checks. There are also exempt (non-countable) assets. Exemptions generally include one’s primary home, personal belongings, household items, a vehicle, burial funds up to $1,500 or a life insurance policy with a cash value up to $1,500, non-refundable pre-paid funeral agreements, and IRA’s and 401K’s in payout status. “Payout status” means that one’s required minimum distribution (RMD) is being withdrawn.

Home Exemption Rules
For home exemption, a Nursing Home Medicaid or HCBS Waiver applicant must live in their home or have Intent to Return, and in 2023, their home equity interest must be under $1,033,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity that is owned by the applicant. If the applicant’s spouse lives in the home, it is automatically exempt regardless of any other circumstances. For Regular Medicaid, there is no home equity interest limit.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, the New York Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger portion of a couple’s assets for the non-applicant spouse of a Medicaid Nursing Home or HCBS Waiver applicant. This is intended to prevent the non-applicant spouse from becoming impoverished, and in 2023, allows that spouse to keep 50% of the couple’s assets, up to a maximum of $148,620. If 50% of the couple’s assets is under $74,820, the non-applicant spouse can keep 100% of their assets up to $74,820.

While the assets of a married couple are also considered jointly owned for Regular Medicaid, there is no Community Spouse Resource Allowance for a non-applicant spouse.

Medicaid’s Look-Back Rule
New York has a 60-month Medicaid Look-Back Period for Institutional (nursing home) Medicaid that immediately precedes one’s Medicaid application date. During this period, Medicaid scrutinizes all asset transfers to ensure none were gifted or sold under fair market value. This includes transfers made by one’s spouse. The “look back” is intended to discourage persons from gifting assets to meet Medicaid’s asset limit. Violating the Look-Back Rule is cause for a Penalty Period of Medicaid ineligibility. Note that the Look-Back Period does not apply to Regular Medicaid.

The U.S. Federal Gift Tax Rule, which in 2023, allows individuals to gift up to $17,000 per recipient without filing a gift tax return, does not extend to Medicaid eligibility. Giving gifts under this rule violates Medicaid’s 5-year Look-Back Period.

 An important change is coming; The Look-Back Period will be implemented for home and community based long-term care services. This is formally referred to as Community Medicaid in NY and includes home health care, adult day care, personal care assistance, and assisted living services. The “look back” will be 30 months (2.5 years) instead of 60 months as it is for Institutional Medicaid. The earliest the state plans to implement this change is March 31, 2024.
Medical / Functional Need Requirements

An applicant must have a functional need for long-term care Medicaid. For Nursing Home Medicaid and HCBS Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. This determination is based on an assessment of needs. Furthermore, additional criteria may need to be met for specific program benefits. As an example, for a Medicaid Waiver to cover the cost of home modifications, an inability to safely and independently live at home without modifications may be required. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living may be required, but a NFLOC is not necessarily required.

 

Qualifying When Over the Limits

There are other ways for New York senior residents to qualify for Medicaid if they do not meet the financial eligibility requirements above.

1) Medically Needy Pathway – New York has a Medicaid Excess Income Program that allows persons over Medicaid’s income limit to still become income-eligible if they have high medical bills. Also called a Spenddown Program or Surplus Income Program, one’s “excess income” goes towards medical bills, such as medical supplies, prescription drugs, and doctor visits. In 2023, the Medically Needy Income Level is $1,677 / month for a single applicant and $2,268 / month for a couple. The “spend down” amount is the difference between one’s monthly income and the Medically Needy Income Level. This can be thought of as a deductible. Once the “spend down” has been met, one will be Medicaid eligible for the remainder of the month. The Medically Needy Asset Limit is $30,180 for an individual and $40,820 for a couple.

2) Pooled Income Trusts – Disabled persons in NY who have income over Medicaid’s income limit can become income-eligible by depositing their “excess” income into a Pooled Income Trust. A type of “Supplemental Needs Trust”, this option can eliminate one’s need to “spend down” income, as discussed above. While income deposited into the trust does not count towards Medicaid’s income limit, trust funds can only be used for limited purposes, such as paying the Medicaid recipient’s bills.

3) Asset Spend Down – Persons who have countable assets over NY Medicaid’s asset limit can “spend down” assets to become asset-eligible. For instance, one can pay past due medical bills (within the last six years), pay for in-home care, and make home modifications to improve safety and independence, such as installing wheelchair ramps, stair lifts, and redoing a bathroom to be wheelchair accessible. One can also prepay funeral and burial expenses, as well as pay off their mortgage or credit card debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s Look-Back Rule and can result in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

 Our Spend Down Calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount.

4) Medicaid Planning – The majority of persons considering Medicaid are over the income and / or asset limit(s), but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid Planning Professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as protect their home from Medicaid’s Estate Recovery program. Connect with a Medicaid Planner.

 

Specific New York Medicaid Programs

1) New York Managed Long Term Care (MLTC) Program Waiver – MLTC is intended for seniors who require a Nursing Facility Level of Care, but who prefer to live at home or in an assisted living facility. Long-term care supports are provided to promote independence and may include personal care assistance, adult day care, meal delivery, and home modifications. Persons can self-direct their personal care services via a service delivery option called the Consumer Directed Personal Assistance Program (CDPAP). This allows one to hire the personal care assistant of their choosing, including select relatives.

2) New York Community First Choice Option (CFCO) – This is an option that allows elderly individuals to receive long-term Home and Community Based Services under the state Medicaid plan. These benefits might include assistance with daily living activities, home health aides, and assistive technology. The consumer-directed option, CDPAP, mentioned above, is available to CFCO program participants.

3) New York Assisted Living Program (ALP) – ALP pays for services in adult care facilities for seniors who require a Nursing Home Level of Care. These services might include skilled nursing, personal care, personal emergency response systems, and housecleaning.

4) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental care and eye care, may be available.

 

How to Apply for New York Medicaid

Seniors in New York can apply for Medicaid in person at their Local Department of Social Services (LDSS) office, or alternatively, they can call their local office and apply via phone. There is not an option for New Yorkers 65+ years old to apply online. For program questions or for application assistance, persons can call the Medicaid Helpline at 1-800-541-2831. One’s local Area Agency on Aging office may also be helpful in answering program questions and assisting persons with applying for Medicaid.

New York Medicaid applicants should be certain that all eligibility requirements are met prior to submitting an application for benefits. For seniors who have income and / or asset(s) greater than the allowable amounts, Medicaid planning can be invaluable. Furthermore, the application process is complicated and assistance with the process may be welcomed. Familiarizing oneself with general information about the application process for long-term care Medicaid can be helpful.

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