Find Out How We Can Help

Medicaid releases new regional rates

On Behalf of | Jan 14, 2021 | Medicaid

Medicaid is a government program (funded by monies combined from federal, state, and local governments) that provides health care coverage for low-income individuals suffering from any number of medical conditions.

Long-term care can be prohibitively expensive for many. Eligibility for Medicaid or other government benefits might literally make the difference between affording much-needed professional assistance and hobbling care together from a network of family or friend caregivers. For wealthier families, qualifying for Medicaid might prevent having to diminish a lifetime’s worth of savings otherwise intended for the next generation, so it is important for a broad range of people.

What numbers just came out?

The Office of Health Insurance Programs of the state’s General Information System recently released the 2021 nursing home rates. These, sorted by region, help local district commissioners and Medicaid directors calculate the asset transfer penalty period for the payment of services for nursing homes and other long-term care facilities.

The rates are based on an average of private pay nursing facility costs in each of the state’s seven regions. The rate for New York City (including all five boroughs) is $13,037. Contrast this with the Long Island area, the rate for which is $13,834, and the Rochester area, with a rate of $13,020.

What do these rates mean?

These rates set guidelines for transfer penalties during the New York Medicaid (also known as “Medicaid Assistance”) look-back period. Basically, if the person seeking Medicaid benefits for a nursing home/long-term care facility stay gives away or sells off assets within the look-back time period, he or she will face a penalty unless the transfer falls under an exemption. The penalty computes based on the monies transferred, and entails a number of months, starting at the time a patient enters a nursing home and applies for Medicaid. During the penalty time, Medicaid pays no benefits.

How can an estate planning attorney help?

Medicaid planning is key to a comprehensive estate plan. With life expectancies getting longer, more of us will need long-term care at some point. A skilled lawyer can help establish trusts or use other estate planning tools to ensure eligibility for government benefits and, at the same time, prevent the loss of estate assets to cover nursing home care.