Why Use an Attorney to Apply for Community Medicaid?

Q: My daughter completed my Community Medicaid application for me. Do I still need to consult with an elder law attorney?

A: While you can submit an application for Community Medicaid on your own, it still is a good idea to consult with an elder law attorney at some point. There are important estate planning steps that you can take to better protect your income and assets that a layman may not know.

Community Medicaid, home-care Medicaid, pays for a variety of medical services that enable individuals to "Age in Place." Medicaid long term care is for those who need assistance with activities of daily living (e.g. dressing, bathing, toileting, and feeding). Community Medicaid will pay for personal home-care aides so that recipients can stay in their homes and avoid a nursing home. How many hours a recipient qualifies for a week depends on the level of assistance needed with the activities of daily living.

To be eligible for Community Medicaid, one must meet the income and asset limits. These are two distinct categories. For 2023, the income limit for Community Medicaid applicants is $1,697 per month for individual applicants, including a $20 disregard. Without further planning, any income in excess of this monthly limit has to be paid to the Department of Social Services each month as a contribution toward any care received. To avoid this, an elder law attorney can enroll you in a Pooled Income Trust.

Pooled Income Trusts are established and managed by non-profit organizations for the benefit of people with disabilities. Medicaid applicants can deposit any excess income into a Pooled Income Trust each month to stay under the monthly income limit. Then, the Medicaid recipient can submit bills for household expenses to the Pooled Income Trust. The trust will pay those bills from the excess income deposited. It is important to not let money accumulate in the Pooled Income Trust because when the applicant passes away, the balance goes to the charity.

Further, if you are married, you may not need a Pooled Income Trust. If your spouse's income is below $3,715, they can capture enough of your income to bring them up to that level of spousal allowance.

The asset limit for Community Medicaid applicants in 2023 is $30,182 for individuals. Additionally, the primary residence of the applicant is exempt up to a maximum equity value of $1,033,000. However, while a primary home is exempt for purposes of determining eligibility, Medicaid may have the right to place a lien on the property. Medicaid can place a lien to recover the value of services provided if the recipient is not survived by a spouse and the property is part of their probate estate. A probate estate meaning that the property passes through the applicant’s Will or by intestacy if there is no Will. An experienced elder law attorney may be able to protect the home from this estate recovery.

If you are thinking about applying for community Medicaid or already receiving benefits, it is advisable to talk to an Elder Law Attorney. An elder law attorney can help you get the most out of your benefits and avoid estate recovery after you pass away.

Brittni Sullivan, Esq. and Dylan Stevens, Esq. are attorneys at Burner Law Group, P.C. focusing their practice areas on Estate Planning and Elder Law. Burner Law Group P.C. serves clients from Manhattan to the east end of Long Island with offices located in East Setauket, Westhampton Beach, New York City and East Hampton.