Medicaid for nursing home and home care in New York

Who qualifies

You must be 65 or older, blind or disabled, and meet income and resource levels. For nursing home care or long-term home care, you also must need that level of help.

If your spouse stays at home

New York protects part of a couple's money for the spouse who stays at home:

Home equity: for nursing home care and community-based long-term care, your home equity must be $1,130,000 or less.

What counts and what does not

• Income: Medicaid takes $20 off your gross monthly income before comparing it to the level.
• Not counted as resources: you can own your home, a car and personal belongings and still qualify.
• Counted: bank accounts, stocks and other savings above the resource level.

Gifts and the look-back

For nursing home care, Medicaid looks back 60 months at money or property you gave away or sold for less than it was worth. A transfer can cause a period when Medicaid will not pay for nursing home care. New York has proposed a 30-month look-back for home care. Ask your local office whether it applies to you.

Excess Income (spenddown)

If your income is over the level, you can still get Medicaid through the Excess Income program. The amount you are over is your "spenddown." Each month, you either:

• show medical bills equal to your spenddown, or
• pay the spenddown amount to your local social services office.

Then Medicaid covers the rest of that month's care. Many people who need home care use this program.

What Medicaid pays for

Nursing home care

Medicaid pays the nursing home. Most of your income goes toward the cost of your care. You keep a small amount for personal needs, and you may keep income for a spouse at home (see the table above).

Care at home

• Managed Long Term Care (MLTC): adults 21 and older who have both Medicare and Medicaid and need community-based long-term care for more than 120 days must join an MLTC plan to keep getting those services, unless they are excluded. Plans cover care management, home care (nurses, home health aides, therapy), personal care, adult day health care, medical supplies, emergency response systems, transportation to appointments, dental, eye and hearing care, and home-delivered or group meals. Hospital care, doctor visits and prescriptions are not part of the plan's payment; they are billed to Medicare or regular Medicaid.
• Three kinds of plans: partial capitation MLTC plans, Medicaid Advantage Plus (MAP), and PACE. The Independent Assessor decides which you can join.
• PACE (Program of All-Inclusive Care for the Elderly): for people 55 and older who need nursing-home-level care and live in a PACE service area. PACE is not offered everywhere.
• CDPAP (Consumer Directed Personal Assistance Program): lets you hire your own aide, including a friend or family member, but not a spouse. All CDPAP members work with one statewide company, Public Partnerships LLC (PPL): 1-833-247-5346.

How to apply

1. Apply for Medicaid if you do not have it yet:
   • Outside New York City: at your county Department of Social Services. The list of county offices is at health.ny.gov.
   • In New York City: through HRA, at an HRA Medicaid office, or call the HRA Medicaid Helpline at 1-888-692-6116.
2. Ask for an assessment of your care needs from the New York Independent Assessor: call 855-222-8350 (TTY 1-888-329-1541). The assessor checks whether you need long-term care and how much.
3. Choose a plan if you need home care for more than 120 days. You can choose an MLTC plan or PACE where it is offered.
4. Send proof your local office asks for, such as income letters, bank statements and records of any property you sold or gave away.

Questions: call the New York Medicaid Helpline at 1-800-541-2831.

After you apply

• Renewals: Medicaid must be renewed, usually once a year. Answer renewal letters on time.
• Report changes in income, resources or address to your local office.
• Appeals: your notice explains how to ask for a fair hearing and the deadline. Ask quickly so you do not miss it.
• Estate recovery: after death, New York may seek repayment from the estate of a person who got Medicaid at 55 or older, or who lived permanently in a nursing home.

Things people often miss

• You can own your home and still get Medicaid.
• Too much income is not the end. The Excess Income program and the spouse allowances can help.
• You can choose your own aide through CDPAP, including a family member who is not your spouse.
• People 60 and older who are not eligible for Medicaid can ask their county Office for the Aging about EISEP, a state program for help at home.

Free help

• NY Connects: free help finding long-term care services. Call 1-800-342-9871 or visit nyconnects.ny.gov.
• HIICAP Medicare counseling: 1-800-701-0501.
• New York Medicaid Helpline: 1-800-541-2831.

See also paying for a nursing home, Medicare, and all benefits in New York.

Phone numbers: Free help lines for New York agencies

Check what you may qualify for