New York Medicaid pays for long-term care — a nursing home or a home health aide — but only for people whose assets and income fall under the program’s limits. Most of our clients are over those limits when they first call. Our job is to bring them under the limits lawfully, while keeping as much of what they own as the rules allow for the people they want to have it. Below are the techniques we use, and how each one works.
The seven tools we use to qualify a client for Medicaid
Which tool fits depends on whether the applicant is still at home or already in a nursing home, whether there is a spouse, and which relatives are in the picture.
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Medicaid Trusts
A Medicaid Trust is the number one tool for long-term Medicaid planning. Assets moved into the trust stop counting against the applicant once the look-back period has run. The trust is only worth having if it meets New York’s requirements; a defective trust is one Medicaid can disregard, which is the outcome the whole plan is designed to avoid. We draft trusts that comply with New York Medicaid eligibility rules, and none of ours has been disqualified.
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Special Needs Trusts
Where the applicant, or a loved one, is disabled, a Special Needs Trust may allow that person to receive Medicaid and SSI while the trustee uses the trust’s assets to provide for needs the benefits do not cover.
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Gift and Loan
This technique lets an applicant transfer essentially half of their assets to a loved one without incurring a penalty. It works right away, even when the applicant has already entered the nursing home. We prepare an opinion letter and a promissory note so that the arrangement is very difficult for Medicaid to challenge.
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Caregiver Contracts
A caregiver contract lets the applicant pay a loved one for the care that person actually provides, so the money leaves the applicant’s name as compensation rather than as a gift. Our contracts use the correct wage calculation and the formalities New York requires, so they stand up to Medicaid’s review.
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Qualified Transfers
A person can transfer property to certain qualified relatives and still get Medicaid without a waiting period. We tell clients whether a particular relative qualifies and, if so, provide an opinion letter saying why.
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Spousal Refusal
Medicaid rules allow a person entering a nursing home to qualify by transferring assets to the spouse who remains at home, who then signs a refusal to contribute. We prepare the form and structure the transfer to minimize the chance that Medicaid sues the at-home spouse for reimbursement.
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Medicaid Annuity
An annuity is often the final piece of an eligibility plan, converting a lump sum that counts as an asset into an income stream. We draft it within the parameters Medicaid sets and make sure it is actuarially sound, which is what makes it hard for Medicaid to challenge.
Planning the whole picture
A Medicaid plan should not undo the client’s estate plan. The techniques above are chosen and combined so that the client qualifies for Medicaid and still passes assets to the people they choose, with an eye on estate taxes as well. If a transfer will trigger a penalty period, we calculate it in advance; our page on the New York Medicaid penalty period explains how that calculation works.
We also represent applicants after a denial. If the Department of Social Services turns down an application, we handle the Fair Hearing and, where necessary, the Article 78 proceeding that challenges the agency’s decision in court. We deal regularly with the New York City Department of Social Services and its staff, and we know its regulations.
Where we practice
We represent Medicaid applicants throughout New York City — Manhattan, Brooklyn, Queens, the Bronx and Staten Island — and in Nassau, Suffolk and Westchester counties. To find out whether you or a family member can qualify, call 212-233-1233 or email [email protected].
