Medicaid FAQ

Frequently Asked Questions

What is Medicaid?

Medicaid is a health care program paid for by the state and federal governments to provide medical care for those who cannot afford it themselves. In order to qualify, you must have high medical bills, be a recipient of SSI or Supplemental Security Income and also meet certain state financial requirements.

Who may qualify to receive Medicaid?

In New York, there are particular eligibility requirements that must be met if a person is to qualify for Medicaid. Generally, these include low income individuals, disabled persons or people over the age of 65. To qualify for Medicaid in New York City, you will need to pass income and asset tests. However, there are some exceptions and it is therefore important to discuss your particular situation with an attorney experienced in handling these matters.

If I make more money that the eligibility requirements outline, can I still qualify for Medicaid?

Even if you make more money than the level outlined in Medicaid eligibility requirements, you may still qualify to receive benefits. The same may apply if you have assets that exceed requirements, but this will vary on a case by case basis. If you are pregnant, disabled, under 18, certifiably blind, or over 65 you should still be eligible.

Can I keep some of my income if I receive Medicaid benefits or am in a nursing home paid for by Medicaid?

You are allowed to keep a small portion of your income if you receive Medicaid or are in a nursing home or assisted living facility. You may be able to keep income for personal use or for your family if they are your dependents.

Do I have options to protect my assets so I can still qualify for Medicaid?

If you have assets that you would like to protect from Medicaid or would like to preserve these for your spouse or children, a New York City elder law attorney at our firm can talk to you about your options in establishing a Medicaid asset protection trust or exploring another avenue of asset protection.

Can I protect excess income if I receive Medicaid?

In some situations a person receiving Medicaid may be required to pay excess income (over a certain monthly amount) toward his or her medical care. A pooled income trust will allow for excess income to be directed into a trust that pays the person's expenses.

Will I still have co-pay bills, even with Medicaid?

Some individuals are completely exempt from paying co-pays, talk to your attorney to find out for sure. Some services are subject to co-payments such as lab tests, medical supplies, inpatient hospital stays, some non-urgent emergency room costs, pharmaceutical drugs, over the counter drugs and clinic visits. You are only liablle however, to pay a maximum of $200 in co-payments a year.

What is a community spouse?

A community spouse is the husband or wife of a personal that is living in a nursing home or has been institutionalized. This spouse however, is not living with them but instead at their home residence.

Do I need to renew my Medicaid?

Yes. Medicaid must be renewed on an annual basis and it can usually be done by phone, by mail or online. Make sure that they always have your most current home address so you are receiving your Medicaid mail, otherwise the mail cannot be forwarded.

What is a “lookback” period?

This is for Medicaid applicants that are in search of nursing home care. The department of social services will look into your financially history and investigate the transactions that go back 60 months-5 years before you applied for coverage. They do this because they want to ensure that you did not sell or give away any of your personal property or assets for less than the market value price for that specified time period. If they do find that assets were sold for less than fair market prices, they will impose a penalty period which will make you ineligible for Medicaid coverage for a specific length of time.

Familiarize Yourself With Medicaid Benefits

Find out more about your options in taking advantage of all the benefits that Medicaid may have to offer you and your family. We understand how complex and frustrating the Medicaid process can be, which is why we are here to help! Let us worry about all the legal loopholes and requirements and so you can focus on more important things like your family and their wellbeing. Contact elder law attorney Matthew Melnik at our firm today for qualified and dedicated legal counsel with Medicare.