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Community Medicaid: The At-Home Care Option

Many Americans swear that they’ll never go to a nursing home. There is a stigma that it is a last resort option for people who are dying. In truth, many nursing facilities defy the stereotypes and provide positive environments where elderly people can live their final years productively with top-notch professional care and socialization with peers. For some people, the nursing home truly is the right choice. But for those who want to stay at home with loved ones, pets, and comfortable surroundings, the government provides an option known as Community Medicaid.

Private paying for care at home can easily result in costs of over $10,000 per month. For those who qualify, Medicaid will provide care in the home without cost. To qualify, clients can only have about $15,000 in assets and $800 in income. But unlike chronic care Medicaid for nursing home purposes, there is no five year look-back period on asset transfers. As such, individuals looking to qualify can move money, property, and other assets into an irrevocable trust or to a family member just one month before they apply. In doing so, people can get down to the $15,000 resource level quickly, without draining their funds in a spend-down.

Qualifying from an income perspective is more complex. A great many retired persons have an income (social security, pensions, IRA distributions, etc.) that exceeds the permitted amount. Their recourse is to create a pooled income trust. Across New York State, there are numerous nonprofit organizations that run trusts to help people qualify for Medicaid. Individuals can submit their excess income to the pooled trust on a monthly basis. Then, they can send bills (rent, taxes, credit cards, etc.) to the pooled trust and the trust will pay the bills. The money in the trust will roll over from month to month, but there is no death benefit. As such, it is important to have enough bills to send so that the money is nearly exhausted on a monthly basis. If an individual’s income is thousands of dollars more than his/her expenses, then the individual may end up submitting thousands of dollars to the pool which they will not recover. In cases of very high income individuals, it may make more sense to private pay then apply for Community Medicaid.

Because qualifying is relatively easy and staying in the home is an attractive option, Community Medicaid seems like the perfect choice. For many people, this is the case. But it has limitations:

  • The county (via their independent evaluators) decides how many hours of care a patient will get. Sometimes, it can be 24-hour care. But in many cases, the number of hours is not enough, and has to be supplemented by private paying.
  • Services providers, known as managed long-term care agencies, need to be available to actually deliver the care. Community Medicaid services are most commonly delivered through private companies that employ home health care workers and receive reimbursement from the county. While Orange County and the regions to the south and east are well served by such agencies, some upstate areas do not have the necessary service providers in place to deliver home care services.
  • It takes time to apply. The counties vary, but it may take a number of months to get a Medicaid approval. Most service providers will expect to be compensated during that Medicaid pendency period, rather than deferring for later reimbursement.
  • The service does not recreate a nursing home in an individual’s house. If someone needs a very high level of care from a team of professionals, a nursing home may be a more appropriate option. Furthermore, nursing homes permit socialization with peers that does not happen in the home care environment.

The advantages of Community Medicaid are clear cut. It allows sick elderly people to stay at home, near friends and family, and receive the care they need where they are most comfortable. Further, it does not require the rigorous document gathering and advance planning that a five year look-back period does for nursing home purposes. Individuals can make asset transfers and seek to become eligible as late as one month before requiring care. But all those interested should have an ongoing conversation with their family members and a qualified elder law attorney. While finances and asset protection are critical concerns, creating a care plan that makes an individual most comfortable is of paramount importance.

It’s never the wrong time to meet with an estate planning attorney and discuss what you can do now to protect your assets and your family.

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Michael Wagner is an associate concentrating on elder law and estate planning.  He can be reached by phone at 866-303-9595 toll free or 845-764-9656 and by email.
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