Medicaid presents medical benefits for those with low incomes. Many of the people seeking coverage under Medicaid have multiple and complex medical conditions. This program is the primary source of long-term care for many Americans for a wide array of health services. Those who meet these standard requirements are supposed to be guaranteed coverage. It’s important to understand the circumstances that could influence a person’s eligibility.
How Medicaid is administered
The state regulates how Medicaid is organized and what criteria must be met for eligibility. New York seniors over 65 who do not meet these eligibility requirements could become eligible if they have high medical bills. This coverage can apply to prescriptions, medical supplies and physician visits. Since the medical crisis of the past year, these criteria have been recently updated. A resident who needs Medicaid coverage needs to fall into the following categories for income level limits:
- An individual can be eligible if their annual income is $10,600 (a monthly total of $884, plus $20 disallow).
- A couple may be eligible if their annual income is $15,600 (a $1,300 monthly total).
If qualified, the resources available could total:
- $15,900 for an individual
- $23,400 for a couple
Provisions for couples
In the typical case that only one spouse needs Medicaid coverage, the community spouse may be able to keep half of their total assets up to a limit. These assets are deemed not available to the person receiving Medicaid benefits. New York State issues the relevant 2021 Medicaid Income and Resource Levels for New York State as follows:
- The Federal Community Spouse Resource Allowance maximum is $130,380.00.
- The State Community Spouse Resource Allowance minimum is $74,820.00.
When one spouse enters an assisted living facility or nursing home, there are spousal impoverishment rules made to ensure the non-applicant spouse has enough financial means to live. A Minimum Monthly Maintenance Needs Allowance (MMMNA) allows some married applicants to transfer a portion of their monthly income to a non-applicant spouse. The Community Spouse Minimum Monthly Maintenance Needs Allowance (MMMNA) is $3,259.50.
The home equity limit for Medicaid coverage of nursing facility services and community-based long-term care is $906,000.00.
Getting the coverage you need
If you’re suffering from an ongoing condition and need fulltime care, you need to pursue whatever Medicaid benefits you may be eligible for. Don’t let a person’s care needs ruin your family’s finances. Learn about the waivers available for spouses.