How a Medicaid Lawyer Can Help You Pay For Nursing Home Care

Medicaid is a vital government program for helping people who meet the program’s eligibility by providing health care coverage. Its beneficiaries include low-income adults, pregnant women, elderly people and adults with disabilities. Medicaid is a joint federal-state program; that is, the federal government sets the standards and the states administer it. It was established in 1965, alongside Medicare, by President Lyndon B. Johnson as part of his Great Society program. Note that Medicare is a different government program that provides healthcare coverage, through reimbursement for healthcare providers, for Americans over 65 years old.

Here are some important facts to know about Medicaid:

• Approximately one in five Americans have Medicaid, though the number varies across states. This ranges from 11% in Utah to 34% in New Mexico.
• Medicaid is the key source of health insurance for certain populations. 
• In 2023, Medicaid covered nearly 35% of children, and 1 in 6 adults. 
• Medicaid accounts for 20% of all health care spending, and more than half of spending on long-term care.
• People who qualify for Medicaid based on age or disability account for more than half of spending. 
• Medicaid coverage facilitates access to care, improves health outcomes, and safeguards against medical debt. 

In New York, approximately 7.5 million people receive health care benefits via Medicaid. Throughout the United States, Medicaid benefits are provided to approximately 90 million people.  

How Can Elderly Americans Benefit from Medicaid? 

If you or a loved one need nursing home care, Medicaid provides several avenues to help pay for such services. As you probably know if you have spent any time at all reading about long-term care, nursing homes are extraordinarily expensive in the United States. New York State’s Partnership for Long-Term Care reported that the estimated average rates for annual long-term care in the seven New York regions ranged from $146,000 to $176,000 in 2024. This cost is not something that most people can achieve without shedding assets and spending down inheritances meant for children and grandchildren. So how do you go about obtaining Medicaid?

These are the basic requirements for Medicaid eligibility:

• You must be a U.S. citizen, or a qualified non-citizen;
• Your income must be below your state’s Medicaid eligibility requirements;
• Your assets must be below your state’s Medicaid eligibility requirements; 
• You must have significant medical expenses that exceed your income.

If you can meet these eligibility requirements, Medicaid covers nursing home services. (Note that assisted living situations are generally not covered.) For eligible individuals, Medicaid also covers certain in-home services for nursing care. 

The way it typically works is as follows:

• Medicaid is need-based, so you will have to show that you have inadequate financial resources to pay for your long-term nursing care. For example, in New York, the monthly income eligibility limit is $1,800 for individuals. The income eligibility limit is $2,433 if both spouses are applying. In addition to any salary you make, Social Security payments and pension payments count toward this income eligibility limit. 
• There are also asset limits that are included in the eligibility requirements. Though these can vary by state, in general, such assets as real estate, retirement accounts, and investment accounts are counted toward the asset limit. Typically, these asset limits are quite low. In New York, the limits are $32,396 for 2025.  

After doing the math, many people realize that they do not meet Medicaid eligibility limits. This is where Medicaid’s “spend down” comes in. Medicaid spend down involves reducing your assets so that you can qualify for Medicaid. There are a number of ways to spend down assets, including transferring assets to a trust, or spending money on paying off a mortgage, credit cards, and making home repairs. New York has a 60-month “look-back” period to determine whether assets were gifted or transferred at below fair-market value in order to qualify for Medicaid. If it is determined that such gifts or transfers were not allowed under the program requirements, there will be a period of Medicaid ineligibility.

In New York, most cases will receive an eligibility determination within 45 days. Medicaid applications can be denied for failure to meet eligibility requirements, failure to submit all required documentation, and other reasons. If you’re denied, you can request a reversal, reapply for Medicaid, or appeal a denial, depending upon the situation. 

New York offers several other avenues for New York residents to qualify for Medicaid if they do not meet the financial eligibility requirements. These include:

• New York Managed Long-Term Care Waiver – This is for seniors who qualify for nursing care, but prefer to live at home, and includes such services as personal care and meal delivery;
• New York Community First Choice Option – This could include home health aides, assistive technology and other services; and
• Nursing Home Transition and Diversion Waiver – This program offers services to transition a senior from a nursing home back to community living. 

This is not an all-inclusive list, and other options exist. Medicaid law is complex, and it is important to contact a Long Island Medicaid lawyer to help you plan for your future. 

Possible Changes to Medicaid in 2025

There is a significant possibility that there will be changes to the federal Medicaid system in 2025. The most likely scenarios are federal funding cuts and financing reforms. House Republicans are considering in excess of $2 trillion in cuts, including imposing a per capita cap, reducing the government’s share of the Affordable Care Act, and imposing Medicaid work requirements, among other policy changes being considered. The net result at the state level would likely be reducing the number of beneficiaries, reducing the amount each beneficiary receives, and implementing work requirements for Medicare recipients.   

Other Ways a Long Island Medicaid Lawyer Can Serve You

As you’re considering and planning for your future as a senior, in addition to Medicaid planning, there are a number of other important actions that your Long Island Medicaid attorney can help with. These include:

• Advance Directives – Of particular importance are Advance Directives. Advance Directives include health care proxies, living wills and power of attorneys. All of these documents allow you to make certain decisions, in advance, about your financial and medical decisions. If you fail to put Advance Directives in place, a court may be required to name a guardian for you in the event of your incapacity. A guardian will make financial, medical and other life decisions on your behalf if you cannot. More than one person may serve in a guardianship role. If you do not have any family members who can or want to serve, the court can appoint someone outside of the family to serve. 
• Long-Term Care Insurance – Long-term care insurance is recommended and can be an important tool to help you pay for nursing homes, assisted living, in-home care, and other services. However, insurers often resist paying legitimate claims, and it’s often difficult to predict how much coverage you need. Elder Law attorneys can help you decide if it’s right for your goals and financial situation.
• Irrevocable Trusts – You can often obtain eligibility for Medicaid by creating an irrevocable trust, also known as a Medicaid Asset Protection Trust. For example, if you place your home and investments into a MAPT, they are not included in the asset limits when calculating Medicaid eligibility. A MAPT allows you to designate beneficiaries who will receive your assets when you pass, and can protect them from capital gains taxes. It’s important to remember that the “look back” period discussed above will apply here. 

Contact Davidow, Davidow, Siegel & Stern

As the saying goes, aging is not for the faint of heart. Our bodies change and our physical abilities decline. We may suffer from memory loss and forgetfulness. But there have been startling advances in aging over the past several decades. Geriatric medicine is an important medical subspecialty, and one that more and more talented doctors take on due to the deep relationships they are able to create with their elderly patients. One aspect of aging well is feeling confident about your financial situation, now and into the future. Have you done the planning necessary to be comfortable and protected? If so, you are more likely to feel like aging offers you a new stage of growth and opportunity. 

Here at Davidow, Davidow, Siegel & Stern, we have helped people manage their financial futures for over 100 years. Our experienced team of estate planning, Medicaid, and elder lawyers strive to ensure a holistic approach to your financial well-being as you age. Whether you need guidance in setting up advance directives, spending down your assets such that you qualify for Medicaid-paid nursing home care, or evaluating long-term care insurance, we have the experience and expertise to help you make these important decisions. In addition to understanding the law, we pride ourselves on keeping current about prospective legislative, regulatory, and policy changes so that we can help our clients anticipate forthcoming changes. Don’t hesitate to contact us today.