Medicaid


1. What is the "five year look back period"?

The "look back period" refers to the time frame for which an applicant for Medicaid must produce financial documentation. The New York State Medicaid program offers two distinct Medicaid benefits: Community Medicaid and Institutional Medicaid. Community Medicaid covers hospitals, doctors, durable medical equipment, and home care services. An application for Community Medicaid with home care services requires production of only three months of back financial records. Different rules apply to an application for Institutional Medicaid benefits, which covers services received at a skilled nursing facility. For Institutional Medicaid, an applicant must produce five years of financial documentation. The Medicaid Agency "looks back" over this five year financial history to see whether the applicant divested him/herself of assets for the presumed purpose of qualifying for Medicaid. If the Agency discovers that the applicant or the applicant's spouse made a gift within the look back period, the applicant is disqualified for Institutional Medicaid coverage for a period of time unless the applicant can rebut the presumption that the transfer was made for the specific purpose of receiving Medicaid.

2. Can I qualify for Medicaid benefits while I own my own home?

The short answer to this question is…maybe. In New York State, up to $758,000 of equity in a Medicaid applicant's home is exempt in 2011. To the extent that the equity in an applicant's home is below this level, ownership of a homestead will not necessarily disqualify the applicant for institutional Medicaid benefits. In some situations, the applicant may be required to sign a statement manifesting his/her intent to return home after being discharged from a skilled nursing facility. By signing this statement, the homestead is not considered in determining eligibility for Medicaid, but the county providing Medicaid benefits has the right to impose a lien against the home to recover the benefits conferred. If the applicant actually returns home, the lien is extinguished.

3. Do I have too much income to qualify for Medicaid?

Income will not disqualify an applicant for Medicaid in New York State so long as the applicant has sufficiently high medical expenses. Depending on whether the applicant is applying for Community Medicaid or Institutional Medicaid, the applicant's income will be treated differently. For Community Medicaid, to the extent the applicant's countable income (after allowed disregards) exceeds $767.00/month in 2011, the "excess income" must either be contributed toward the Medicaid recipient's medical expenses or deposited into a qualifying "pooled income trust." (Pooled income trusts are administered by select non-profit organizations for the benefit of disabled persons.) In the Institutional setting, all of a Medicaid recipient's income, after allowed exemptions, must be remitted to the skilled nursing facility in which the recipient resides as a type of co-payment obligation.