Mr. Goodwin is everything you want in an attorney: professional, honest, thorough, and genuinely caring. He always explains things clearly, so I understood exactly what was happening and what to expect next. His attention to detail and persistence really stood out. Looking back, I feel lucky to have found him. He guided me through the whole process expertly, and I deeply appreciate all his hard work. Would definitely recommend him to anyone needing legal help.
When your income increases while you are on New York Medicaid, you have 10 days to report it to Medicaid. If you fall over the income limit, you can try to spend down your assets to make you fall below Medicaid's income limit. However, if this is not enough, you should consider exploring other healthcare options that can cover long-term care.
Reporting Income Changes with Medicaid
Medicaid recipients are responsible for reporting changes in income to their local Medicaid office within 10 days from such change. Income changes that must be reported include starting a new job or receiving a pay raise, and changes in household composition that affect income, such as a spouse or child moving in or out. Failure to report income increases can result in overpayment of benefits and potential legal consequences, such as repayment requirements, fines, termination of Medicaid coverage, and potential criminal charges.
To report income changes to Medicaid, recipients should contact their local Medicaid office and provide documentation of the income change, such as pay stubs or a letter from their employer confirming their new income, bank statements showing additional income, and updated tax returns or W-2 forms. The Medicaid office will review the information and determine if the recipient's eligibility or coverage will be affected. If the recipient's income exceeds the Medicaid eligibility limits, they may receive a notice of discontinuance or be required to pay a premium to maintain coverage.
Potential Consequences of Income Increases
Potential consequences of income increases can lead to possible changes in Medicaid coverage. If your income exceeds the Medicaid eligibility limits, you may lose your Medicaid coverage entirely. You may need to explore other health insurance options. One option is employer-sponsored health insurance. If you or a family member gain employment that offers health insurance benefits, you may be required to enroll in that plan. However, you may still be eligible for Medicaid as a secondary insurance to cover services not included in your employer-sponsored plan if you meet the eligibility criteria, which includes income and other factors. Another option is the New York State of Health Marketplace, where you can purchase a private health insurance plan. Depending on your income, you may qualify for tax credits and subsidies to help lower the cost of premiums and out-of-pocket expenses. If you are 65 or older, or have a disability that qualifies you for Social Security Disability Insurance (SSDI), you may become eligible for Medicare. Medicaid can work alongside Medicare as a secondary insurance, helping to cover Medicare premiums, deductibles, and copayments. Lastly, if you lose Medicaid coverage and are unable to afford private health insurance, you can seek care at community health clinics that offer services on a sliding-scale fee basis. These clinics charge based on your income and ability to pay, ensuring access to essential health services.
Spending Down Income
Other legal strategies to reduce income when your income increases is to spend it down. Spending down involves using excess income to pay for medical expenses, such as health insurance premiums, prescription drugs, medical supplies, and other qualifying medical costs. By doing so, you can effectively lower your countable income to meet Medicaid's eligibility threshold.
Acceptable medical expenses for spending down may include:
- Doctor visits and medical procedures
- Prescription medications
- Over-the-counter medications prescribed by a doctor
- Medical equipment and supplies, such as wheelchairs, hearing aids, or diabetic supplies
- Transportation costs to and from medical appointments
- Home modifications for medical purposes, such as installing a wheelchair ramp or grab bars
It's important to keep detailed records and receipts of all medical expenses used for spending down, as Medicaid may require proof of these expenses. Additionally, some counties in New York may offer a pay-in program, where you can pay the spend-down amount directly to the Medicaid office instead of incurring medical expenses.
Another option for spending down is to establish a pooled income trust, also known as a supplemental needs trust. This is a special type of trust managed by a non-profit organization that allows you to deposit your excess income into the trust. The trust then pays for your qualifying medical expenses, effectively lowering your countable income for Medicaid purposes. Pooled income trusts can be particularly helpful for individuals with recurring monthly excess income.
Medicaid recipients have the responsibility to report any significant changes in income to their local Medicaid office. Failure to do so can result in overpayment of benefits and potential legal consequences. If the income increase may lead to a loss of Medicaid coverage, there are legal strategies to spend it down to fall within the Medicaid income limits. Consulting with a Medicaid lawyer is essential. Should you need assistance, we at the Law Offices of Albert Goodwin are here for you. You can call us at 212-233-1233 or send us an email at [email protected].
About the Author
Albert Goodwin Esq. is a licenced New York attorney with over 17 years of courtroom experience. His extensive knowledge and expertise make him well-qualified to write authoritative articles on a wide range of legal topics. He can be reached at 212-233-1233 or [email protected].
