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Frequently Asked Questions about Medicaid
regarding nursing home care or care in your home
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Is the county going
to take my house?
NO. If you (or your spouse) reside in your home it remains your homestead
and is not counted as a resource. Only when you can no longer live
there does it become a resource. At the time of your death your house
becomes part of your estate and will be used to help pay your creditors,
including the Department of Social Services (DSS). When you receive
Medicaid after the age of 55, DSS is entitled to recover the Medicaid
expended on your behalf up to the value of your estate. Table
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What happens to my house if I
go into a nursing home?
The Department of Social Services (DSS) can place a lien on your home
if you go into a nursing home. DSS will not place a lien on your home
if your spouse still resides there, a child who is under 21, blind or
disabled lives there or a sibling with an equity interest in the home
lives there and has lived there for at least one year. DSS will not
place a lien if your physician states this is a temporary stay in a
nursing home. Please ask for Informational Notice for Applicants with
Real Property for more information.
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What is a lien?
A lien is a claim that DSS puts on your real property, while you are
in a nursing home, for the payment of Medical Assistance that the
Department pays or has paid on your behalf. If you return home, the
lien is removed from your property. The Department may still have
a claim against your estate for the Medicaid provided on your behalf.
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Am I going to have any
money to live on? How much money can I keep?
People on Medicaid are allowed to have income and resources up to
certain levels. The levels change at the beginning of each year and
are different depending on the size of your household and the type
of care of which you need Medicaid. For someone residing in their
home, applying for Medicaid to help pay for prescription, hospital
bill or some personal care in the home, the following levels are effective
in 2001:
| HOUSE SIZE |
ONE |
TWO |
|
| MONTHLY INCOME |
$634 |
$925 |
Levels for larger households are |
| COUNTABLE RESOURCES |
$3,800 |
$5,550 |
available upon request |
If the application is for nursing home care, the levels
are different depending on whether you are a single individual (divorced,
legally separated, widowed or never married) or if you are married.
A single individual would have the same resource level as a household
of one above. They keep a $50 personal allowance from their total income
each month and their remaining income is paid to the nursing home each
month. A married couple, of which only one requires Medicaid for nursing
home level of care would be eligible under the spousal impoverishment
program. Table of Contents-
What is spousal impoverishment?
This is a program under NYS Medicaid that allows higher income and
resource levels for married couples, one of whom requires nursing
home care, while the other remains in the community. The community
spouse can keep income and resources up to the levels listed below:
| MONTHLY INCOME |
$2,232 |
(level for 2002) |
| COUNTABLE RESOURCES |
$74,820 |
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These figures are counting the combined income and resources
for the couple whether held jointly with the spouse or any other person,
or singly. In addition, the institutionalized spouse is entitled to
keep resources of $3,800 plus income of $50.00 per month. This income
is often called the personal allowance. Please ask for Informational
Notice for Institutionalized Spouses for more information. Table
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What are countable resources?
Resources are different from income. Some examples of resources include
cash, bank accounts, stocks, bonds, IRA's and property. Other potential
resources may be explored when you apply. The resources you are allowed
to have while receiving Medicaid are exempt during your lifetime.
This means that DSS cannot make you use them for your care. However,
upon death, the balance becomes a part of your estate and is used
to help pay your creditors, including the Department of Social Services.
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What can I give away?
Can I give anything away?
If you have given away resources for less than fair market value and
you make an application for nursing home care within 36 months of
that transfer, it could affect your eligibility for certain types
of care that medical assistance may cover. Please ask for Informational
Notice transfers of Assets for more information. You may wish to contact
an attorney for additional information concerning transfers of assets.
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What is a spenddown?
In question #3 income levels were
shown. If a households income is higher than the allowed level shown,
they can "spend down" their income each month to the allowed
level with a medical expense and Medicaid can pay remaining outstanding
medical bills in that month. For example, if a single person has Social
Security income of $700 per month, they would need to "spend
down" $75 each month to be eligible for Medicaid that month.
($700 minus $625=$75) That $75 would be paid on a medical expense,
such as a home care agency providing care in the home, and Medicaid
would then pay other medical expanses that month such as prescriptions
or doctor visits. Table of Contents
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What is a 36 month review?
What does a resource review mean?
NYS Medicaid regulations state that any application for Medicaid for
nursing home level of care requires a review of income and resources
of the applicant ( and their spouse) for the 36 months (3 years) prior
to the application. For example, if an application is made in February
2002, the resource review starts February 1, 1999 and all resources
owned beginning from that date and during the next 3 years are examined
and reviewed. Please refer back to question #5 for a few examples
of the type of resources that are reviewed, A 36 month review is only
required for applications for nursing home level of care. Table
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What kind of information
is needed for an interview?
You can request a copy of Documentation needed for an Interview for
a complete listing. You should keep 3 years of records for all banks
and financial institution accounts that you have including IRA'a,
annuities, trusts, etc. Monthly statements are required for each account
owned, whether still open or closed during the 36 month review period
(question #9). Requesting replacements of statements can be costly
as banks have a fee for that service. If the application is not for
nursing home level of care, only the current month's statement is
needed for all resources. Table of Contents
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What does Medicaid cover?
Will Medicaid pay my past due bills? Can I keep my doctor?
Medicaid can pay for hospital care, doctor, dentist, and prescription
costs. It may also pay for health care aides in your home and nursing
home costs. Medicaid can cover bills retroactive for the three months
prior to your application if you were eligible in those months. In
order for Medicaid to pay on any bills, your doctor or hospital must
be an enrolled Medicaid provider. You should check with your doctor
to see if he/she is a Medicaid provider.
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How
long does the application process take?
The actual interview to file an application can take up to two hours.
The Social Welfare Examiner has 45 days to make a decision on your
application. It can take more time depending on the amount of information
you provided and how soon you were able to provide it. It's always
best to provide as much information as possible at the interview.
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This information is provided by the Chautauqua County Department of Social
Services.
If you would like any of the informational notices listed, please call
716-661-8147 in the Jamestown Area for a copy.
In the Dunkirk area, please call 716-363-4000, ext. 8147.
For more information: NYS
Office for the Aging
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