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What You Need to Know About Community Medicaid for Care in the Home

Many people are interested in avoiding nursing homes and receiving Medicaid services in their own homes. Community Medicaid provides these services and can be an ideal solution for many seniors, but there are limitations.

Here is what you need to know:

1.Community Medicaid does not simulate a facility level of care in your home.

Home health care aides can be extremely helpful, and you may also be able to obtain some medical equipment and supplies. But as attractive as it is to stay in your comfortable home surroundings, the level of care will not be the same as it would be in a nursing home staffed by a team of professionals 24 hours per day.

Independent evaluators determine the level of care and number of hours that a Community Medicaid applicant will receive. The care may be very significant and effective for an elderly or disabled person, but for those with severe mental or physical disabilities, a nursing home with round-the-clock care may provide a higher level of support. Every situation is different, and each requires analysis and attention.

2.You must qualify from an income and asset perspective.

The resource level for Community Medicaid is $15,750 for individuals. This is the maximum amount of money or other assets someone is allowed to have in his/her name and still be able to qualify for Medicaid. But this type of care does not require the same five year look-back period that chronic care Medicaid for nursing home care requires.

You could transfer or spend down your assets in one month and qualify the next. But you should consult an attorney before making major asset transfers to evaluate how such transfers may affect your estate plan or your ability to qualify for Medicaid for nursing care in the future.

The permissible income levels for Community Medicaid are currently $875/month for unmarried people and $1,284/month for married couples. Unfortunately, this is a level of income that does not afford most people a high quality of life in New York State.   Many people are in a position where they make significantly more income than this (social security, pension etc.), but also still not enough to cover their care out-of-pocket.

For those looking to qualify for Medicaid with excess income, the options are to either spend down income on medical expenditures each month, or to shelter income using a trust.

3.Pooled Trusts Can Help

Pooled trusts are large trusts managed by nonprofit organizations for disabled seniors to shelter excess income while receiving Medicaid. There are more than a dozen pooled trusts to choose from in New York State. These pooled trusts have sub-accounts for all of their members, and can be used to pay bills that each member submits, such as utilities, insurance, and living expenses. There are some trustee and administration fees involved, and when a member passes away there is no death benefit, so the money goes back into the pool for administrative expenses.

But even if you are not able to provide bills to spend down all of your income and you end up leaving some money in the pool after your death, it can still be of significant benefit to use a pooled trust because Community Medicaid provides essential home care services each day that you may not otherwise be able to arrange and afford.

This is not intended to be legal advice.  You should contact an attorney for advice regarding your specific situation.  This article appeared in the Times Herald Record 55 Plus.


Michael Wagner is senior counsel concentrating on elder law and estate planning, wills and trusts.  He conducts several Estate Planning Seminars throughout the year.
He can be reached by phone at 866-303-9595 toll free or 845-764-9656 and by email.
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