There appears to be a lot of confusion regarding payment for long term care services for the elderly at home.
Unlike medical and rehabilitation services, which are generally paid for by Medicare and health insurance, long term care services, known as “personal care services”, are not covered by those sources. The costs of these services might be covered by a typical “long term care” insurance policy. However, those policies are separate from standard health insurance policies.
Personal Care Services, also known as “custodial services”, are those relating to assistance with activities of daily living such as bathing, dressing, and feeding. The cost of a personal care aide or a home health aide may be paid for through the Medicaid program if the applicant is poor enough to qualify. In 2015, an applicant qualifies if his or her total resources are below $14,850 and monthly income is $845 or less. The applicant’s house and an IRA in payout status are not included in determining eligibility.
There are two important aspects to Medicaid coverage for home care that many people do not know:
1. Unlike nursing home Medicaid in New York, which has a five year “look back” eligibility requirement, no such requirement exists to qualify for the home care Medicaid program. Thus, if an applicant gives away assets and becomes financially qualified, he or she will be eligible for home care Medicaid beginning the following month.
2. Even if an applicant has income greater than $845 per month, he or she still can qualify for home care Medicaid coverage by joining a pooled trust and paying his or her excess income monthly to the trust administrator. The trust administrator uses the excess income (after subtracting small trust administration fees) to pay the applicant’s expenses that are not covered by Medicaid or Medicare, such as utility costs, groceries, real property taxes, homeowner’s insurance and home maintenance and repair costs.
The use of the pooled trust has allowed many elderly persons to continue to live in their homes and receive assistance through Medicaid with their activities of daily living.
Copyright 2015 Joseph A. Bollhofer, Esq.
Joseph A. Bollhofer, Esq., is an attorney who practices law in the areas of elder law, Medicaid, estate and business planning and administration, real estate and personal injury. He is a member of the National Academy of Elder Law Attorneys (NAELA) and of the Elder Law, Real Property, and Surrogate’s Court Committees of the Suffolk County Bar Association and the Elder Law, Real Property Law and Torts, Insurance and Negligence Sections of the New York State Bar Association. He has been serving area residents since 1985 and is admitted to practice law in New York and New Jersey. His office is located at 291 Lake Ave., St. James, NY. (631-584-0100). For reprints of this article and others send a request to firstname.lastname@example.org or visit www.bollhoferlaw.com.