Questions about Medicaid in NY State. Asking for a friend, her spouse has dementia.
My friend has been taking care of her husband (80 years old) for a couple of years now. She has health problems of her own but is able to function pretty well.
Combined income for both is about $5000.00 a month including her husband's pension. They own a house free and clear.
She called VNA and was first told the spend down would be $750.00 and then was told by same person that the spend down would be around $2,500. She was hoping to get a visiting nurse to help her.
Needless to say we are both confused.
Husband wears pullups and refuses to change them so friend yells at him.
This past week he fell down twice and was brought by ambulance to hospital. Friend was hoping they would keep him there but they sent him home.
What does my friend think it best at this point? She is confused and either wants a visiting nurse or place her husband in a nursing home but is not sure of the spend down amount.
Any advice would be appreciated!
Thanks.
6 Answers
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Now the difficult part is finding a good Elder Lawyer.
Thanks again JoAnn!
NYC vs upstate NY have different regulations as well. You will want to find one in the same county as the person residence is too. Each county is serviced by a different office. The attorney has relationships with managers in the office that will help with any questions on application.
https://www.agingcare.com/local/elder-law-attorneys
The sticky for couples is the date the application is filed is the date that LTC Medicaid affixes the couples income and assets. Often called the snapshot date. LTC Medicaid has income and assets maximums different for each of them. Most States have the NH spouse to have no more than 2K nonexempt assets but NY does like 31K, CA does even higher. CS assets $ amount also vary by State. Federal max for a CS assets this year is abt 162K & Federal minimum is abt 32K. But States can do this all differently….. some do split in 1/2, others do the 32K, others do 162K. If they are over the assets allowed, they do a spend down. Spend down can be done to benefit either of them NOT just to the benefit of the NH spouse.
Their income (SSA $, other retirements, annuity in pay out mode) for both of them matter for LTC Medicaid. For the CS their own income usually is not ever a factor for his eligibility. The only time it might be is of the CS is still working w/high salary. His income under LTC Medicaid rules is a required Share of Cost (the SOC) paid by him to the NH less a smallish Personal Needs Allowance (the PNA). His income has to be under whatever NYS has as its monthly income max. Most States do $2,901 income max. If over there are ways to suss this out. Could be the overage goes into a pooled income, or a Miller Trust, or just gets paid to the NH…. don’t fret, there are ways to deal with too too much income.
But if there is a CS, having NH spouse required to pay the NH all his monthly income can be a serious problem. If a couple is interdependent on both incomes to keep their household afloat, that Share of Cost if paid, is a crisis for the CS.
There is a way to deal with this…..CSRA aka Community Spouse Resource Allowance. It’s a waiver filed as part of the LTC Medicaid application. Think of it as kinda like old school alimony. Doing the CSRA is not always simple & why having a savvy atty matters….
Jack & Jill live in medium2high Cost of Living city in TX which has a PNA of $75 a mo. Jack is 82 end stage Parkinson’s and his care needs to be happening in a NH. Jack is medically “at need” for LTC Medicaid. Jack makes 2700 in SSA every mo. Jill is 70 and she makes $1800 in SSA every mo plus $400 from a pension. They have a mortgage of $2000 a mo and she has higher than usual drug costs. 100K in savings. Their state does Federal max assets for a CS, so Jill can set aside 98K in her own savings account and Jack can have the 2K nonexempt asset max allowed for those on LTC Medicaid. But Jill does NOT have enough $$$ to live on by just her income as there is that pesky mortgage. Their elder law atty figures out all possible living costs Jill needs and files a waiver for Jill to get $2500 of Jack SS$ paid (waived) to her each month. Voila! Jacks new SOC is $125 and a separate PNA of $75. The NH tends to not ever mention CS waivers….
Big take away is a CS does NOT have to become impoverished in order for NH spouse 2 b eligible for LTC Medicaid. But doing what’s needed that is legit and ok for how a caseworker reviews applications is not straightforward or simple. It’s experienced atty work.
Friend and hubby live in Upstate NY if that makes any difference. Friend doesn't get a pension, hubby does. He was the money maker in the family.
I do understand about a Community Spouse but how do I know which attorney is the most experienced? In my own experience I have met all kinds of attorneys, some a lot smarter compared to others.
Are the attorney's listed in the link recommendations from members that belong to Agingcare? Just curious.
Thanks for your response!
Then we applied for LTC Medicaid for my father.
plus there all those lil things that couples tend to do… like have each other as their beneficiary. If CS gets hit by a bus and so predecease their NH spouse, then all the CS assets become the NH spouse’s. Big bad mistake as that $ now makes NH spouse ineligible as they have now have $/resources. So the atty will need to do a codicil to their will so this doesn’t happen & go over all other “beneficary of” accounts, so they too do not have this as an issue.
A kid active in their widowed parents life with a well down POA, imho, can total do the application for them on their own. But for couples it’s way complex and not straightforward. It’s savvy atty work.