The reality is that we all stand a good chance of needing some type of long-term care during our retirement years. At the same time, most of us would prefer to retain as much autonomy and independence as possible for as long as possible. If you reach the point where living in your own home is no longer possible, but around the clock nursing home care is not necessary, an assisted living facility might be a viable alternative. While not as expensive as nursing home care, assisted living costs are still high which may lead you to wonder if Medicaid will help cover those costs. The Harrison Medicaid lawyers at the Law Offices of Kobrick & Moccia discuss whether Medicaid will pay for assisted living expenses in New York.
The Cost of Assisted Living
The cost of long-term care (LTC) is high throughout the nation; however, New Yorkers pay, on average, considerably more than residents of other states. Nationwide the average cost of a year in a nursing home was about $100,000 for 2018. New Yorkers paid, on average, just over $146,000 for that same year. By the same token, the average cost of a year in an assisted living facility for 2018 was $48,000 across the nation while New Yorkers paid, on average, about $51,000.
Medicaid Basics
Although Medicaid is considered a federal health care program, the funds for Medicaid come from both the federal government and the individual state governments. Consequently, the rules governing Medicaid also come from both the federal government and the individual states governments. The federal government sets certain standards and requires state Medicaid programs to cover certain types of care and services; however, it also gives the states considerable flexibility with regard to the services they provide, particularly when it comes to paying for alternatives to nursing home care, such as in-home care and assisted living facilities.
New York State’ Assisted Living Program
One option for New Yorkers who cannot safely remain in their own home, yet do not need the level of care provided by a nursing home, is the Assisted Living Program (ALP). This program provides approximately 5,500 units statewide in licensed assisted living communities. The ALP program is not restricted to Medicaid recipients only; however, almost 90 percent of participants are on Medicaid. To be eligible for the ALP program you must meet the following requirements:
- Be at least 21 years of age. There is no maximum age.
- Applicants must be medically eligible for nursing home care. However, their functional ability cannot be so limiting that they require nursing home care around the clock. In addition, they must have a degree of self-mobility that will enable them to function in an assisted living environment.
- If you will rely on Medicaid to pay for the program, you must meet Medicaid eligibility requirements, which include, but are not limited to, the following:
- Monthly income for an individual is limited to $859 and for a couple, with both spouses as applicants, is limited to $1,267.
- The value of the applicant’s non-exempt assets cannot exceed $15,450 for a single applicant and $22,800 for couples, given both spouses are applying for benefits.
If you qualify for the Assisted Living Program, the basic cost for a program participant to reside in an approved assisted living residence will be covered; however, services that may be offered beyond the “basics” are not paid for by ALP, such as:
- Adult Day Health Care
- Personal Care
- Room & Board (note this is not paid for by Medicaid, but by other funding sources for persons eligible for Medicaid)
- Housekeeping
- Medical Supplies / Equipment
- Skilled Nursing (as required)
- Physical and Occupational Therapy
- Recreational Activities
- Personal Emergency Response Services
Will You Qualify for Medicaid?
The Medicaid eligibility requirements are complex and subject to change each year. To ensure that your assets do not prevent you from qualifying if you need to in the future you should consider incorporating a Medicaid planning component into your comprehensive estate plan.
Contact Harrison Medicaid Lawyers
Please feel free to download our FREE estate planning worksheet. If you have additional questions or concerns regarding the New York State Assisted Living Program, or Medicaid eligibility, contact Harrison Medicaid lawyers at the Law Offices of Kobrick & Moccia by calling 800-295-1917 to schedule your appointment.
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