What Can be Done to Qualify for Medicaid in New York City

As a leading Medicaid lawyer in NYC, Albert Goodwin can assist you with the following:

• Creating a Medicaid Asset Protection Trust
• Joining a Pooled Income trust
• Structuring a Gift and Loan transaction
• Defending agains allegations of Medicaid fraud
• Defending against Medicaid estate recovery

As a Medicaid Lawyer in NYC, we can help you set up a Medicaid Asset Protection Trust

A Medicaid trust is a legal entity that shields your income or assets from being considered when your Medicaid eligibility is determined. As a Medicaid lawyer in NYC, we can help you create a medicaid asset protection trust. A Medicaid trust allows you to qualify for Medicaid even if your income or assets are over the allowed limit. You can have the government pay for medical care, home health aides, and nursing home. A New York Medicaid trust is a valuable tool that helps protect your assets, allowing you to leave your estate to your family instead of using your money to pay for medical and nursing home care.

Navigating through joining a Pooled Medicaid Trust

A pooled income trust is an arrangement that allows a person to have a charity manage their money in exchange for that money not being counted as their income for purposes of eligibility for Medicaid. As a Medicaid lawyer in NYC, we can help you join a pooled Medicaid trust. The pooled income trust account functions similar to a managed bank account. The monthly non-discretionary bills, such as rent, mortgage, cable, healthcare premiums, etc., can go straight to the pooled income trust for payment. The variable expenses, such as food, clothing, travel and entertainment expenses, can be charged to a credit card, with such bill being submitted to the trust at the end of the month for payment.

Structuring a Gift and Loan transaction

Even when someone is about to enter the nursing home, it is still possible to preserve half of their assets while qualifying for Medicaid. One of the last resort tactics we use is the gift and loan technique known as “half and half.” As a Medicaid lawyer in NYC, we can help you structure a gift and loan transaction using a letter, promissory note and other documentation.

Defending agains allegations of Medicaid fraud with the help of a Medicaid Lawyer in NYC

As a Medicaid lawyer in NYC, we can help you fight allegations of Medicaid fraud. If you received a Medicaid fraud investigation letter, you are worried about what’s going to happen next. We employ time tested and battle-worn tactics to beat Medicaid fraud investigations and achieve results for our clients. You have the option of not coming to the interview but sending your lawyer instead. You can use that right to obtain the best result in the investigation. You need a Medicaid lawyer NYC to either prove that the allegations have no basis or minimize the damage.

Defending against Medicaid estate recovery

As a Medicaid lawyer in NYC, we can help you minimize Medicaid estate recovery. Medicaid estate recovery in New York is more common than people realize. Under Social Services Law (SSL) Section 369, the state of New York may, and is actually required, to recover Medicaid benefits upon the death of a recipient. It applies to persons who received Medicaid benefits at the age of 55 or older or to persons who, regardless of age, were permanently institutionalized prior to their death. The state can recover the amount of Medicaid correctly paid from the date the recipient turned 55 years of age or the date of permanent institutionalization, whichever occurs first. You need a Medicaid lawyer in NYC in order to minimize estate recovery.

For all your Medicaid lawyer needs in NYC, you can call the Law Offices of Albert Goodwin at 212-233-1233.

The Five-Year Look-Back Period

One of the most important rules in Medicaid planning is the five-year look-back period for nursing home Medicaid. When an applicant applies for institutional Medicaid, the state reviews all asset transfers in the five years before the application. Transfers that occurred during this period for less than fair market value can trigger a penalty period during which the applicant is ineligible for Medicaid coverage.

The look-back rules:

• Apply only to nursing home Medicaid, not to community Medicaid (Medicaid covering home care).
• Review all gifts and below-market transfers in the five years before application.
• Calculate a penalty period based on the value of the transferred assets divided by the regional cost of nursing home care.
• The penalty period starts when the applicant would otherwise be eligible for Medicaid — that is, after the applicant has spent down to the asset limit but is still ineligible because of the prior transfers.

This timing is important: the penalty doesn't start until the applicant is otherwise eligible, which means the applicant could be ineligible for care precisely when they need it most.

Income and Asset Limits

New York Medicaid has specific income and asset limits that change periodically. As of recent guidance:

• Community Medicaid asset limit (single applicant): Approximately $30,000-$31,000.
• Community Medicaid asset limit (married couple, both on Medicaid): Higher amount.
• Nursing home Medicaid asset limit (single applicant): Approximately $30,000-$31,000.
• Spousal resource allowance: The community spouse can retain a specified amount (the Community Spouse Resource Allowance, which fluctuates annually).
• Income limits: Different limits for community Medicaid and nursing home Medicaid.

These limits change periodically. Current limits should be verified before relying on specific figures for planning.

Spousal Protections

The spousal impoverishment rules protect the community spouse (the spouse not in the nursing home) when the institutionalized spouse applies for Medicaid:

• Community Spouse Resource Allowance. The community spouse can retain assets up to a specified amount without affecting the institutionalized spouse's eligibility.
• Minimum Monthly Maintenance Needs Allowance. The community spouse can retain enough income to meet a specified minimum.
• Spousal refusal. New York allows the community spouse to refuse to contribute to the institutionalized spouse's care, with the state then pursuing recovery against the community spouse.

These protections allow the community spouse to maintain their living standard while the institutionalized spouse receives Medicaid coverage.

Common Asset Protection Strategies

Several strategies are commonly used to protect assets while qualifying for Medicaid:

• Medicaid Asset Protection Trusts. Irrevocable trusts holding assets that, after five years, are no longer counted for Medicaid eligibility.
• Pooled income trusts. Charitable trusts that hold excess monthly income for the benefit of the beneficiary.
• Spend-down on exempt assets. Converting countable assets to exempt assets (e.g., primary residence improvements, prepaid funeral plans).
• Annuities. Converting lump sums to income streams that may be more advantageous for eligibility.
• Promissory notes. Creating loans that count as income rather than assets.
• Caretaker child exception. Transfers to a child who lived with the parent and provided care that delayed institutionalization.

Each strategy has specific requirements and limitations. The right approach depends on the family's specific circumstances.

The Caretaker Child Exception

One of the most useful exceptions to the look-back rules is the caretaker child exception. The exception allows transfer of the parent's home to a child who:

• Lived in the home with the parent for at least two years immediately before the parent's institutionalization.
• Provided care during that time that allowed the parent to remain at home rather than enter institutional care.

The transfer to the caretaker child does not trigger a penalty period. The exception recognizes that family caregivers have made substantial contributions and should not be penalized for the parent's eventual need for institutional care.

The Half-and-Half Strategy

When planning hasn't occurred and the applicant is about to enter a nursing home, the half-and-half strategy can preserve approximately half of the applicant's assets:

1. The applicant gifts half of countable assets to family members.
2. The applicant loans the other half to family members in exchange for a promissory note.
3. The applicant applies for Medicaid; the gift triggers a penalty period.
4. The loan payments cover nursing home costs during the penalty period.
5. After the penalty period, the applicant qualifies for Medicaid with reduced assets.
6. The gifted half is preserved for the family.

The strategy requires precise execution and proper documentation. Mistakes can result in penalties for both halves of the assets.

Estate Recovery

After a Medicaid recipient's death, New York's estate recovery program may seek to recover the Medicaid costs paid during the recipient's life. Estate recovery applies to:

• Recipients who were 55 or older when receiving Medicaid.
• Recipients permanently institutionalized when receiving Medicaid.

Recovery is generally limited to assets in the deceased's probate estate. Non-probate assets (trusts, joint accounts, payable-on-death accounts) are generally not subject to recovery in New York, though some exceptions apply.

Planning to reduce probate exposure can substantially reduce estate recovery. Living trusts, joint ownership, and beneficiary designations can move assets out of the probate estate where they would be subject to recovery.

Medicaid Fraud Investigations

Medicaid fraud allegations can arise from various sources: anonymous complaints, data analytics flagging unusual patterns, audits, or referrals from other agencies. The investigation process can result in:

• Civil penalties.
• Repayment demands.
• Disqualification from future Medicaid benefits.
• Referral for criminal prosecution in serious cases.

Responding to fraud investigations requires careful navigation. Cooperation must be balanced against the risk of self-incrimination. Counsel can help structure the response to minimize exposure while preserving rights.