Long-term care is not cheap. The cost of employing a home care attendant in the New York City area ranges from $15 to $25 an hour and a nursing home bed runs from approximately $12,000 to $15,000 per month. Finding the right solution to help pay for long-term care is critical. While Medicare gets most of the news coverage, Medicaid still remains a mystery to many individuals. The fact is that Medicaid is the largest source for funding nursing home care. However, there are many myths about exactly who qualifies for Medicaid and what coverage it provides. Here are four myths followed by the real story.

Myth #1: Medicare will cover my nursing home expenses.

While Medicare does provide some coverage for nursing home expenses, the coverage is quite limited and is not long-term. Medicare covers only up to 100 days of “skilled nursing care” per spell of illness, of which only 80 days are fully covered. The patient must start paying a copayment of $148 per day (as of 2013) from the 21st to the 100th day unless he or she has supplemental insurance that will cover the copayment. To qualify for Medicare, the patient must enter a Medicare-approved “skilled nursing facility” or nursing home within 30 days of a hospital stay that lasted at least three days, and the care in the nursing home must be for the same condition.

Myth #2: You need to be poor to qualify for Medicaid.

Medicaid helps needy individuals pay for long-term care, but you do not need to be completely destitute to qualify. Generally, as of 2013, an individual is allowed to have up to $14,400 in assets and up to $820 in monthly income to qualify for Medicaid. In addition, retirement accounts of any amount in payout status are exempt in New York State. However, eligibility for Medicaid is not that cut and dried and often depends on the facts of each case. The rules vary depending on whether an individual is looking for “Community Medicaid”, which covers home care costs, or “Institutional Medicaid”, which covers nursing home costs. Eligibility is also different when the applicant has a spouse. Potential applicants or caregivers are strongly encouraged to explore with an elder law attorney the possibility of qualifying for Medicaid in order to help defray the cost of long-term care.

Myth #3: A prenuptial agreement will protect my assets from being counted if my spouse needs Medicaid.

A prenuptial agreement only works to keep property separate in the event of death or divorce. It does not keep property separate for purposes of Medicaid eligibility. However, a “sick spouse” may still be eligible for Medicaid even if the “well spouse” has assets. A “well spouse” should explore the eligibility rules with an elder law attorney.

Myth #4: I can give away up to $14,000 a year under Medicaid rules.

The rule that allows gifting up to $14,000 per year ($13,000 last year) is an Internal Revenue Service (IRS) rule, NOT a Medicaid rule. The IRS allows an individual to gift up to $14,000 a year without incurring any gift tax liability. However, under Medicaid rules, a gift of $14,000 or any other significant amount will trigger a penalty period. This means that for approximately every $11,000 gifted within the 5 year period before a nursing home Medicaid application is filed, Medicaid will not cover the applicant for one month. It is important to note that there is no penalty period on transfers of assets for community-based Medicaid eligibility.

Dispelling the above myths should encourage individuals or their caregivers to explore Medicaid as an option to paying for long-term care. Medicaid is definitely a viable alternative for many of us and is commonly used. However, the rules are complex and it is critical to consult with your elder law attorney to ensure no stone is left unturned.


Written By:
Ronald A. Fatoullah, Esq., CELA
Ronald Fatoullah & Associates
Great Neck , New York

4 Myths Regarding Medicaid’s Long-Term Care Coverage was last modified: May 17th, 2018 by Ronald Fatoullah, Esq.