Few of us want to consider planning for long term care, however, without this planning, you could find yourself unable to self-pay for an assisted living facility or nursing home, yet also unable to qualify for Medicaid. Medicaid is a “means-tested government entitlement,” which means your income and resources must be below a certain level to entitle you to benefits. Proper planning can both protect your assets and ensure you are entitled to Medicaid benefits should the need arise.
Many people are misinformed regarding Medicaid planning issues, believing there is nothing they can do to protect their assets. In many cases, assets can even be protected at a very late date, although the earlier the planning begins, the better your assets can be protected.
The New York State Department of Health lists the annual estimated 2018 nursing home rate in Long Island as $156,636, with New York City nursing home rates at about $147,828. Our attorneys at Esther Schwartz Zelmanovitz, PLLC are highly skilled and knowledgeable in the use of Medicaid-exempt transfers, irrevocable trusts, and combinations of loans and gifting as well as other planning techniques as tools to protect assets as a part of Medicaid planning.
We can assist you with the Medicaid application process, while always ensuring your interests are the primary concern. Early planning is always the best course of action; our team will ensure your Medicaid application is accurately and professionally prepared.
Recommended reading: NYS Income and Resource Limits for Medicaid (2021)
New York Long Term Care Planning
Any service required to meet the personal care needs of an individual can fall under long term care. A person turning 65 today has nearly a 70 percent chance of needing some level of long-term care services or support in their remaining years. Overall, women will require an average of 3.7 years of long term care services or support, while men will require an average of 2.2 years of long term care services or support.
Specifically, the following percentages of people aged 65 and older will need the stated levels of care at some point in their life:
- 69 percent will require some type of long term care service;
- 59 percent will receive unpaid care in their home for at least one year;
- 42 percent will receive paid care in their home for less than one year;
- 35 percent will receive care in a nursing home for at least one year;
- 13 percent will receive care in an assisted living facility for less than one year, and
- 37 percent will receive some type of facility-based care for at least one year.
While about a third of today’s 65-year-olds will never require long term care, about a fifth of those who do require long term care support will need it for more than five years. As you can see, long term care planning should be a priority.
Although medical care is certainly a significant part of long term care, many adults may require assistance with activities of daily living (ADL), generally recognized as:
- Bathing and grooming – the ability to shower independently, grooming and maintaining hygiene such as shaving and brushing teeth
- Dressing – the ability to get dressed including opening and closing buttons, hooks, and zippers
- Eating – the ability to feed independently
- Transferring – the ability to walk and transfer to and from a bed to a chair
- Toileting – the ability take care of bathroom needs independently
- Continence – the ability of bladder control and bowel function
One of the primary issues to consider when planning for long term care is how the care will be paid for. There is a misconception that an individual’s long term care will be covered by Medicare or their private health insurance. This is only true in very limited circumstances and usually for only a short duration.
Realistically, home care services are often provided by unpaid family members, or, if paid help is needed, by long term care insurance, spending one’s personal funds, or qualifying for Medicaid long term care government benefits.
Since it can be a daunting task to determine how you can afford the high costs of long term care, it is recommended that those interested in long term care planning or have an immediate need for long term care, consult with an experienced New York elder law attorney. Your elder law attorney can help you qualify for Medicaid benefits, or plan for Medicaid eligibility in the event it may be needed in the future, comprehensively explaining the process, as well as your options.
Common Questions about Medicaid
What is Medicaid planning?
Statistically, many of us will need to reside in a nursing home or similar facility. If you don’t have long-term care insurance, or cannot afford the ever-increasing cost of such insurance, then the remaining options for paying for a nursing facility are to pay out-of-pocket or to rely on government programs that may cover eligible individuals for their final stage of care. There are legal strategies available to arrange your affairs in a way to ensure that you will qualify for Medicaid, while also preserving much of your estate for your final beneficiaries. An experienced elder law attorney can help educate you on the options available to you and your family.
Am I eligible for Medicaid?
There are asset-level or wealth limits to be eligible for state Medicaid. There are also income limits. However, there are permissible and legal strategies to move toward becoming eligible for Medicaid if you are currently in excess of these limits. Speak with an elder law attorney today to explore your options and how you can protect your estate for your loved ones.
How do I protect my money from Medicaid?
With enough advanced notice and with the right advice, you may be able to structure the ownership of your assets in a way that should make the Medicaid benefits available. It’s also possible that if you’ve already tried to give assets away to others, you may have partially or fully disqualified yourself from future Medicaid benefits.
Some of these techniques may require the cooperation of trusted loved ones. Elder law planning results are best achieved when family or close trusted friends are involved in the planning. You may feel nervous about the process, and uncertain if you need to explore elder law planning techniques. Having a trusted family member involved can help you evaluate the need for planning and assist you in exploring the different options available.
Keep in mind that New York State has laws in place to protect seniors and those suffering from variations of incapacity from elder abuse. Good elder law planning will help minimize the risk of elder abuse. But those same state laws may, at times, limit the participation of family members or unrelated advisors from participating in some aspects of planning. A reputable elder law attorney will prepare you for these laws and help you to execute your planning documents in a way that will make sure that your intentions are carried out without interference from others.
What services are available in New York?
We are fortunate to have many great service providers in New York State (or insert your local area – Manhasset/Great Neck). There are wonderful options for assisted living, nursing homes, and memory care facilities. For those with the resources available, there are quality choices of providers of in-home care. And for those with limited resources, there are respectable facilities that honor Medicaid payments and many additional services available through charitable organizations.
Medicaid Planning in New York
Medicaid is a “means-tested” program that addresses the health care needs of those who cannot afford to privately pay for long term care. Medicaid is jointly funded between federal and state for those who are low-income. An individual must be over the age of 65 or disabled, blind, eligible for public assistance, or a recipient of Supplemental Security Income (SSI) to qualify for Medicaid. Further, the individual may only have minimal assets to qualify for Medicaid benefits in New York.
When an application for Medicaid nursing home care is made, in addition to confirming that a person currently meets the financial eligibility requirements, Medicaid rules require a determination as to whether any gifts or transfers by the applicant were made within the prior five years.
The Medicaid nursing home care application requires applicants and their spouses to disclose all financial transactions for 60 months preceding the nursing home application. This is known as the “look-back” period. If an applicant or his or her spouse transferred money or property within this five-year period, Medicaid may impose a “penalty” in the amount of the transfer.
For example, if an individual transferred her home valued at $200,000 to her children or a trust, and then needed nursing home care two years later, Medicaid may approve an application for nursing home care based on the applicant’s current financial means, but impose a “penalty” which would require the applicant to cover the first $200,000 of her own nursing home costs before Medicaid would step in to pay for the care. This is obviously a problem as the applicant no longer has $200,000 to pay for this care.
In New York State, the five-year look-back period is only imposed on nursing home applications, with no look-back period for home care. Because Medicaid long term care has strict rules, including the “look-back” period, it is important to start Medicaid planning as early as possible. Our attorneys at Esther Schwartz Zelmanovitz, PLLC can help you with all the requirements which determine your Medicaid eligibility for benefits.
Getting the Help You Need for Long Term Care and Medicaid Planning from Esther Schwartz Zelmanovitz, PLLC
Long term care and Medicaid planning can be overwhelming, confusing, and stressful. While you want the best chance of success in obtaining Medicaid benefits, navigating through it on your own is simply is not an easy task. Incorrect planning can set you back on the time that you or your loved one may not have. Esther Schwartz Zelmanovitz, PLLC provides individualized attention to each client, crafting a solution that is uniquely tailored to your specific situation.
We help our clients find peace of mind through exceptional service, proven strategies, and high-quality representation. Esther Schwartz Zelmanovitz, PLLC, a top-rated law firm, serves clients’ needs through home visits and evening appointments, and are “serving your legal needs in Long Island, all five boroughs of New York City and statewide.” Contact Esther Schwartz Zelmanovitz, PLLC today for a comprehensive evaluation of your needs.