They use the information to determine citizenship, proper jurisdiction for benefit administration, entitlement for other benefits or health insurance, verification of all sources of income and verification of all resources to aid in determining eligibility. For Nursing Home Medicaid they look at the past five years of all financial accounts (open or closed) to make sure there has not been a transfer of assets or gifting. This five-year period is referred to as the “look-back period.”

No. The Department of Social Services (Medicaid) has NO access to you bank accounts or pension accounts. If someone’s social security or pension is being direct deposited to a bank account, it will continue to be direct deposited. It will be the responsibility of the recipient or their agent to make the proper payment from their bank account for the health insurance premiums and their NAMI (client share) that is required to be paid to the nursing home each month.  You can request that the Social Security benefit be sent directly to the nursing home

Yes. Medicaid recipients in a nursing home are required to pay a client share, referred to as a NAMI – net available monthly income. This is their gross income less exemptions for health insurance premiums and a personal needs allowance. There are NO exemptions from the recipient’s income to pay for unpaid credit card bills, taxes, utility bills or upkeep of a home. The only exemption is for health insurance premiums. This NAMI is paid every month to the nursing home. Even if the recipient is only in the facility part of a month, the full NAMI is owed for that month. Failure to pay the NAMI can jeopardize the recipients Medicaid coverage.

In some instances, Medicaid recipients in a nursing home may ask the nursing home to become their representative payee so that their income from social security goes directly into an account in their name at the nursing home. The same can be done with pension income if desired. This does not automatically happen, and it is not something Medicaid does for you. This arrangement is something you must discuss and set up with the nursing home. Some families prefer this so that they do not have to worry about writing a monthly check to the facility.

The Department of Social Services has set eligibility limits for individuals and couples where one continues to reside in the community. Those limits are adjusted yearly. The DSS will look at the first day of the first month in which there is an unpaid nursing home bill. For consistency they always look at the first day of the month even if the bill started on the 9^th. They will look at the value of all resources on that date. If you are at or under the eligibility limit, you would be considered eligible for that month. If you are over, they will determine if you are over the limit by enough to pay that month’s nursing home bill. If you are, then they will determine you are not eligible for that month, and they will re-do the calculation using the value of the resources on the 1^st of the next month. They continue in this manner until they determine the proper month to start coverage. If you are substantially over the resource level your application would be denied, and you would reapply when you were closer to the eligibility limits.

Sometimes there is an additional payment referred to an excess resources. Following the process described above, if you are over the eligibility limit for the month being reviewed for coverage but not enough to pay the nursing home bill that month, that amount is referred to an excess resources. Those excess resources are required to be paid to the nursing home as a one-time payment to get your resources down to the eligibility.

No. The Department of Social Services (DSS) will not “take” anyone’s property. The DSS will not “take” the house, be responsible for its upkeep or maintenance or be responsible for selling the property. If a home is owned, and there is no community spouse residing in the home, a form called an Intent to Return Home will be filed. That form will exempt the value of the house from the resource calculation done to determine eligibility. The DSS will file a lien against the property so that when it is sold, they will recover the amount of funds they spent on the care of the recipient. Remember, that the recipient’s income cannot be used for upkeep of the home. Any upkeep expenses would need to come out of the recipient’s remaining resources.

The house cannot be transferred without incurring a penalty except in the following limited situations: the transfer of a primary residence is exempt from transfer penalty IF it is transferred to a spouse, a sibling with an equity interest in the home who has lived in the home for at least a year, a child who has lived in the home for at least two years prior to the applicant entering the nursing home and who has provided care to the applicant or a disabled child (Proof of disability would need to be provided and be found acceptable to the DSS)

A life estate created BEFORE the five year look back period is allowable. However, according to Medicaid regulations, a life estate has monetary value. That value will not count toward the resource level during the initial calculations. However, if the property is sold while the recipient is alive, the value of the life estate MUST be given to the recipient. Depending on the value and the recipients remaining resources at that time it could affect their eligibility for a period of time. A life estate created DURING the five year look back period is NOT allowable and would be considered a transfer of assets (gift) and would be penalized.  You can transfer the home back to the parent to avoid the penalty during the application process.

Yes. Medicaid refers to gifts or transfers of money or property (home, vehicles, vacant lots, trailers, etc.) as a “transfer of assets”. NYS law prohibits a transfer of assets in the five-year period prior to asking for Medicaid coverage. The only limited exceptions to this are transfers to a spouse or a disabled child. (Proof of disability would need to be provided and be found acceptable to the DSS). Also, there are limited exceptions for the transfer of a primary residence as discussed under #7.

If any transfers occurred during this 5 year look back period, a penalty or sanction will be applied. In general, it means that there will be a period of time that Medicaid will not pay the nursing home despite the applicant’s resources being low enough to qualify for coverage. Your case manager at Elder Care Solutions will review the transactions in and out of the applicant’s financial accounts and will discuss with you any items that look as though they could be considered a transfer of assets. Currently Medicaid initially requires that ALL transactions of $2,000.00 and more be explained. They can as for any and all transactions to be explained if they see a pattern or have a suspicion that gifting has occurred.

Sometimes people say that they heard from a financial planner or a friend that they could gift a certain amount every year. The Internal Revenue Services (IRS) has different rules about transfers of funds. These are tax rules and NOT Medicaid rules. Medicaid DOES NOT follow IRS rules.

We can continue with the application. Depending on how far along we are in the document gathering process and who signed the consent will determine if additional steps need to be taken. A Power of Attorney’s authority ceases at the time of death. Sometimes a form from the court called a Letter of Administration needs to be obtained by the executor of the will for us to gather remaining documents.