Medicaid Part I

1. Medicaid Part I July 10, 2019 Richard A. Weinblatt, Esq. Haley Weinblatt & Calcagni LLP 1601 Veterans Memorial Highway, Suite 425 Islandia, New York 11749

2. Overview • Medicaid was created in 1965 • The federal Department of Health and Human Services (HSS) has the authority to approve state plans for Medicaid • The immediate responsibility for administering Medicaid is delegated to the Centers for Medicare and Medicaid Services (CMS) • In New York, the program is administered by the New York State Department of Health (NYSDOH) • In Nassau and Suffolk counties, it is the Department of Social Services (DSS) that administers the program • In New York City, the program is administered by the Human Resources Administration (HRA)

3. Overview • The Medicaid program is subject to both federal and state law • Federal regulations can be found in 42 USC of the Code of Federal Regulations • New York State regulations can be found at 18 NYCRR § 360 • State Medicaid regulations cannot be more restrictive than federal

4. Overview • Medicaid is a means tested program designed to limit participation to the poor, however, due to the high cost of nursing home care, Medicaid is now being utilized by the middle-class to avoid becoming impoverished should nursing home care be required

5. Types of Medicaid • Standard Medicaid • Community Medicaid • Chronic Care Medicaid • MAGI Medicaid

6. Non Financial Eligibility Requirements • Citizenship • Residence • The County with Fiscal Responsibility for Payment

7. Non Financial Eligibility Requirements • Individuals Eligible for Standard Medicaid • Individuals Eligible for MAGI Medicaid • Medically Needy Category

8. Financial Eligibility for Standard Medicaid • Resources • $15,450.00 for individual • $22,800 for a married couple

9. Financial Eligibility for Standard Medicaid • Exempt Resources • Homestead • One car (in use) • Certain prepaid burial and funeral expenses • Personal and household property

10. Financial Eligibility for Standard Medicaid • Resources of Community Spouse • Community Spouse Resource Allowance Minimum $74,820 • Community Spouse Resource Allowance Maximum $126,420 • Spousal Refusal • Federal law authorizes spousal refusal for nursing home care only

11. Income General Rules • Includes gross earned income and gross unearned income • Exempt income • German reparations • The first $20 of unearned • The first $65 of earned • Veterans Aid & Attendance benefits

12. Income for Community Medicaid • Monthly income of applicant • Limited to $859 for one person and $1,267 for a family of two. Income in excess will be required to be spent down.

13. Income for Nursing Home Care • All monthly income of a nursing home resident in excess of $50 (the personal needs allowance) plus allowance for health insurance premium and the community spouse Minimum Monthly Maintenance Needs Allowance (“MMMNA”) must be paid to the nursing home. • The MMMNA for 2019 is $3,160.50.

14. Medicaid Chronic Care Transfer of Assets • Overview • Although federal law permits a state to impose a penalty period on the transfer of assets for Community Medicaid, New York State only imposes a transfer penalty on the application for nursing home benefits.

15. Rules for Transfers made prior to February 8, 2006 • Look-back period was 3 years for outright transfers and 5 years for trust related transfers. • Penalty period is calculated by totaling the amount of transfers and dividing it by the regional rate.

16. Rules for Transfers made after February 8, 2006 • The look-back period was extended to 60 months (5 years) for all transfers (outright and trust). • Penalty period is still calculated by totaling the amount of transfers and dividing it by the regional rate. • In 2019, it is $13,407.00 for Nassau and Suffolk counties

17. Commencement of the Penalty Period • 1) Applicant is in a nursing home AND • 2) Applicant is otherwise eligible • Resources at or below $15,450 • Income below the private pay rate for nursing home • Medicare coverage has been exhausted

18. Exempt Transfers • Certain transfers are exempt and do not cause a penalty period • Transfer of exempt property other than a homestead • Transfers between spouses • Transfers to a certified blind or disabled child, or to a trust for the sole benefit of such child • Transfers to authorized SNT • Transfer made for a purpose exclusively other than to qualify for Medicaid • Denial of eligibility would cause undue hardship

19. Exempt Transfer of a Homestead • In addition to the previous slide, the transfer of a homestead is also exempt if the transfer is to: • An adult child who has resided in the home for at least 2 years and has been a caregiver to the applicant • A sibling of the applicant who has resided with the applicant for at least 1 year and has an equity interest in the home • A minor child (any resource can be transferred to a certified blind or disabled child).

20. Home Care / Community • Transfers of resources do not create a penalty period for home care services.

21. Remember • Laws relating to Medicaid are constantly changing and transfers of resources may have tax consequences. Transfers should not be made without the advice of counsel.