FAQs Catalog

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:
Household size of one: $634-monthly income & $3,800-countable resources
Household size of two: $925-monthly income & $5,500-countable resources
Levels for larger households are 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.

Can someone else come in to the office for the interview?

Yes. You should complete and sign the application yourself, if you are able, but you can have someone represent you at the interview. Office for the aging may provide this service for this over 65. If you have named someone as your Power of Attorney, they should represent you.

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.

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.

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 our 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 Health and Human Services.

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.

What does available income mean? Will the county take my check?

Your regular paycheck, Social Security, Pension, Veteran's benefits, interest income are considered income. You continue to receive you income. The Department does not take you income but may consider it available to meet the cost of you medical care.

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.

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.

What if I can't find all the information that's needed for the interview?

You are given a period of time to gather any information needed after the interview is completed, usually two weeks. You can request an extension of time if you find you need it. In order for the examiner to be able to make an eligibility decision on your application as soon as possible, please try to bring as much information as possible to the interview.

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.

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.

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 expenses that month such as prescriptions or doctor visits.

What is CASA?

CASA stands for Community Alternative Systems Agency and is a department in the Department of Health & Human Services. It is staffed by registered nurses that can assess you or your family member and determine what level of care is best for you and if Medicaid can pay that level of care. A Social Welfare Examiner in the Medicaid Department determines your eligibility for Medicaid.

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 $2,232 (monthly Income - level for 2002) and countable resources of $74,820. 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.

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.