Two Medicaid Programs Available:
Community Medicaid (For home and community-based services)
Chronic Medicaid (For nursing home care)
Community Medicaid
What is Community Medicaid?
Community Medicaid provides long-term care services at home or in assisted living programs (not covering room and board). It allows individuals to remain in their home while receiving home health care, personal assistance, and medical services.
Criteria to Qualify
Medical Eligibility
Must require assistance with Activities of Daily Living (ADLs) such as bathing, dressing, eating, mobility/transferring, toileting and continence.
Must qualify for Nursing Facility Level of Care (NFLOC) as determined by the Uniform Assessment System for New York (UAS-NY).
May need skilled nursing care or memory care due to cognitive impairments.
Financial Eligibility (2025)
Income Limit: $1,800. -/month for a single applicant. (Overage might be paid into a pooled trust)
Asset Limit: $32,396. – for a single applicant.
Look-Back Period:Starting in April 202x, a 2.5-year look-back period applies for Community Medicaid, reviewing financial transactions for asset transfers.The lookback period is deferred annually and not in effect now, making Community Medicaid go into effect on the first of the following month after approval (asset transfer).
Programs Supported by Community Medicaid
Managed Long-Term Care (MLTC) Plans – Assigns a case manager. Provides home health aides, nursing, personal care, and therapy. Covers Long Term Care, not health care.
Consumer Directed Personal Assistance Program (CDPAP) – Allows recipients to hire their own caregiver, including certain family members.
Community Medicaid with Long-Term Care – Covers in-home nursing, personal care, and medical equipment.
Nursing Home Transition and Diversity Waiver (NHTD) – Seniors who want to return to the community from a nursing home or avoid a nursing home. Offers care management, home modifications, assistive technology.
Pros and Cons of Community Medicaid
Pros:
Allows seniors to stay at home.
Allows seniors to use some Assisted Living Communities.
Covers doctor visits, prescriptions, and hospital stays.
Less restrictive asset protection (e.g., pooled income trusts).
Spousal impoverishment protections.
Cons:
Limited to in-home services (does not cover assisted living room and board).
Look-back period (starting in April 202x) limits asset transfers. Currently suspended.
Requires approval before services begin, which may take weeks or months.
Chronic Medicaid
What is Chronic Medicaid?
Chronic Medicaid is designed for individuals who need full-time nursing home care in a Medicaid-approved facility. It covers room, board, and medical care for long-term institutionalized care.
Criteria to Qualify
Medical Eligibility
Must require 24/7 medical supervision and assistance with most daily activities.
Must meet the Nursing Facility Level of Care (NFLOC) assessment criteria.
Financial Eligibility (2025)
Income Limit: $1,800. -/month for a single applicant.
Asset Limit: $32,396. – for a single applicant.
Look-Back Period:5-year look-back applies for asset transfers.
Services Covered by Chronic Medicaid
100% coverage for nursing home costs (room, board, and medical care).
Skilled nursing, therapy, and personal care.
Spousal protection rules allow non-applicant spouses to retain a portion of assets and income.
Pros and Cons of Chronic Medicaid
Pros:
Covers full nursing home costs (room, board, and care).
Provides 24/7 skilled nursing care.
Spousal protection laws apply.
Cons:
Strict financial requirements with a 5-year look-back.
Requires institutionalization, meaning loss of independence.
Limited nursing home availability (may have waitlists).
Key Differences Between Community Medicaid & Chronic Medicaid
Choosing the Right Medicaid Program
Choose Community Medicaid if the individual needs assistance at home but does not require full-time nursing home care.
Choose Chronic Medicaid if the individual requires 24/7 care and supervision in a nursing home.
Why Consult an Elder Law Attorney?
Medicaid eligibility and asset protection strategies can be complex. Consulting an estate and elder law attorney can help:
Navigate Medicaid applications and financial planning.
Protect assets using trusts and legal exemptions.
Plan ahead to avoid penalties from the look-back period.
For assistance, reach out to an elder law and estate attorney to ensure you make the right choice for long-term care.
Additional Thoughts:
Private pay assisted living provides a broad spectrum of care options. Some communities, with the proper licensing, can offer advanced clinical support comparable to nursing homes. Additionally, specialized dementia care communities operate under the assisted living model.When considering Medicaid, it’s important to clarify whether the need is due to financial eligibility (low income and assets) or asset protection (using a trust to shield assets).Planning should be done after consulting a qualified Medicaid Attorney and Financial Advisor.
Find compassionate senior care guidance with CarePatrol in Suffolk County, NY. Navigating senior care choices doesn’t have to be a solo journey. At CarePatrol, we understand the unique challenges of aging and are dedicated to finding personalized care solutions for you and your family.With a deep understanding of the local senior services options, Uwe Ross is your ally in maintaining your independence and quality of life.For free professional guidance, connect with Uwe at 631.323.4650 or email [email protected] and take the important step towards peace of mind.
The information provided is for general informational purpose only. Under no circumstances shall we accept any liability. The use and reliance on any information is solely at your own risk.