Will I Lose Medicaid in New York if I Get Married?

You can lose Medicaid in New York if you get married. When a couple's combined income and assets surpass the state's Medicaid eligibility thresholds after marriage, the recipient may find themselves disqualified from the program. This unfortunate situation, often referred to as the Medicaid marriage penalty, highlights the delicate balance between love and financial security for those relying on this vital healthcare assistance.

Impact of Marriage on Medicaid Eligibility

The Medicaid marriage penalty is a situation where tying the knot can jeopardize a Medicaid beneficiary's eligibility for the program. When a non-Medicaid spouse's financial resources, including both income and assets, exceed the state's threshold for Medicaid eligibility, the Medicaid-recipient spouse may find themselves disqualified. Medicaid, being a needs-based program, imposes strict limits on income and assets to determine eligibility. Income limits are generally pegged to a percentage of the Federal Poverty Level (FPL), while asset limits, although varying, are typically quite stringent. In New York, as of 2024, when only one spouse is applying for Medicaid, the asset limit for the applicant spouse stands at $31,175, while the non-applicant spouse can retain assets up to $154,140. If the non-applicant spouse's countable assets surpass this limit, the Medicaid-recipient spouse risks losing their Medicaid coverage.

How Assets are Counted

In New York, Medicaid treats the assets of a married couple as a unified whole, regardless of individual ownership or titling. As an equitable distribution state, New York splits the couple's total countable assets evenly between the applicant spouse and the non-applicant spouse, allocating 50% of the assets to each partner. This equal apportionment of assets forms the foundation for calculating each spouse's countable assets when determining Medicaid eligibility. Countable assets include retirement accounts, such as 401(k)s and IRAs, held by the non-Medicaid spouse, which are factored into the couple's total assets, even if the account is not actively being drawn upon. Additionally, real property owned by the non-Medicaid spouse, apart from the primary residence, is also deemed an asset and can impact the Medicaid eligibility of the spouse receiving Medicaid benefits.

Protections for Spouse of Nursing Home Resident

Medicaid offers a range of safeguards to protect the financial well-being of the community spouse (the non-applicant spouse), ensuring they can maintain a decent quality of life and are not driven into poverty by the expenses associated with their spouse's long-term care needs.

Community Spouse Resource Allowance (CSRA)

The Community Spouse Resource Allowance (CSRA) is the amount of assets the community spouse can retain. In New York, the CSRA is $154,140 as of 2024. The CSRA is calculated using the snapshot date, which is the date of Medicaid application or institutionalization. The total countable assets of both spouses are divided by two. If the result is below the minimum CSRA, the community spouse keeps all assets. If the result is above the maximum CSRA, excess assets must be spent down. A Medicaid planning lawyer like us can help a couple spend down assets without violating the Medicaid lookback period.

Spousal impoverishment protections

Spousal impoverishment protections allow the community spouse to keep their own income and a portion of the institutionalized spouse's income. The community spouse's income is not counted for Medicaid eligibility and includes Social Security benefits, pensions, and employment income. There is no limit on the amount of income the community spouse can have. If the community spouse's income is below the Monthly Maintenance Minimum Needs Allowance (MMMNA), the institutionalized spouse can transfer income to reach the allowance. In New York, as of 2024, the MMMNA is $3,853.50.

Monthly maintenance minimum needs allowance (MMMNA)

The monthly maintenance needs allowance is the minimum income level for the community spouse, ensuring they have enough income to live independently. If the community spouse's income is below this level, a portion of the institutionalized spouse's income is transferred, limited by the maximum needs allowance. The maximum monthly maintenance needs allowance in New York is $3,853.50 per month in 2024. In exceptional circumstances, the community spouse may request a higher needs allowance by demonstrating financial duress. This requires a fair hearing or court order.

Consequences of Not Reporting Marriage to Medicaid

In New York, Medicaid recipients are required to report changes in income, resources, and marital status within 10 days of the change occurring. Failure to report changes within this time frame can result in penalties, even if the change would not have affected the recipient's eligibility.

Penalties for failing to report changes to Medicaid can be severe. If a Medicaid recipient fails to report changes that would have made them ineligible for benefits, they may be required to repay the value of the benefits they received in error. Repayment can be a significant financial burden, as the amount owed can accumulate quickly over time. In addition to repaying erroneously obtained benefits, Medicaid recipients who fail to report changes may also be subject to interest charges and fines. Interest is typically charged on the amount owed, and can add up quickly, making it even more difficult for the recipient to repay the debt. Fines may be imposed as a penalty for failing to report changes, and can be substantial.

In severe cases, where a Medicaid recipient intentionally withholds information or provides false information to maintain their eligibility, they may face criminal charges for fraud. Medicaid fraud is a serious offense, and can result in significant fines and even jail time. If a Medicaid recipient deliberately conceals a significant source of income or assets to maintain their eligibility, they could be charged with fraud and face penalties such as a $250,000 fine and up to 5 years in prison. Criminal charges for Medicaid fraud can have long-lasting consequences, including difficulty finding employment and housing, as well as a permanent criminal record.

Tying the knot can have far-reaching consequences for those relying on Medicaid benefits in New York. To navigate the complex landscape of Medicaid eligibility and ensure an uninterrupted flow of vital healthcare assistance, it is essential to seek the guidance of a knowledgeable Medicaid planning attorney. Our experienced team stands ready to help you understand the implications of marriage on your Medicaid benefits and develop strategies to safeguard your access to the care you need. We represent Medicaid applicants and recipients throughout the state of New York, including all five boroughs of New York City (Manhattan, Brooklyn, Queens, The Bronx, and Staten Island), Long Island, and Upstate New York. Should you need assistance, we at the Law Offices of Albert Goodwin are here for oyu. You can call us at 212-233-1233 or send us an email at [email protected].