Medicaid Home Care in New York State Part 1 – Income Thresholds

This is part 1 in a series of articles regarding eligibility requirements for Medicaid Home Care in New York State for New Yorkers age 65 and older or less than age 65 who have Medicare.  Generally, Medicare does not cover long-term home care.  Therefore, many New Yorkers age 65 and older or less than age 65 who are disabled apply for Medicaid home care. 

To qualify for Medicaid home care in New York, monthly income and financial resources must not exceed certain thresholds.  This article will address the income requirements for a single person in the year 2020

Income is the monthly amount received from all sources.  In 2020*, the monthly income limits are as follows:  $875.00 – for a person living alone and $1,284.00 – for a couple.  Income includes all sources, such as Social Security, pensions, work, IRAs, annuities and gifts.  Exclusions can apply, such as certain war reparations, reverse mortgage payments and direct payments to a landlord by a party who is not legally responsible. 

To ascertain deductions from income, the following is deducted from gross income: (1) $20.00; (2) Medicare Part B premium, Medicare Supplemental insurance and other insurance premiums; (3) earned income: special deductions apply if you or your spouse are working.  If you or your spouse are working, deduct the 1st $65.00 then ½ the remainder from the monthly gross income.  If the remaining amount less the deductions exceeds the $875.00 for a single person or $1,284.00 for a couple, you are not eligible for Medicaid without a spend-down of the surplus.

Example of a single person spend-down scenario is displayed below.  Mary lives by herself, receives $1,968.00 Social Security/month and $300.00 from an annuity/month. 

Gross Income ……………………………………………………………………….        $2,268.00

Less Medicare Part B premium ……………………………………………         ($   135.50)

Less $20.00 income deduction (aged, blind, disabled) ………….       ($     20.00)

Medicaid Countable Income …………………………………………………        $ 2,112.50

Less Medicaid Allowable Income ………………………………………….        ($    875.00)

               Surplus/Month ………………………………………………………..       $ 1,237.50

Here, the surplus exceeds the Medicaid Allowable Income of $875.00 by $1,237.50.  One strategy to eliminate the surplus is to deposit the surplus into a Supplemental Needs Trust or Pooled Trust which can pay monthly expenses.  It is imperative to use the funds in the trust or the funds will eventually be lost to the depositor. 

This article addresses basic income requirements, spend-down options and payment of expenses.  Your specific matter may differ so be sure to reach out to our office directly to discuss your case. 

Stay tuned for part 2 in our series addressing … Financial Resources/Assets

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