What Are the Qualifying Levels?  

Tracking an individual’s resources, or in the case with a Community Spouse, a married couple’s resources is THE MOST IMPORTANT step to take in obtaining Medicaid Coverage.

Verifying what the resources are will clearly show If the applicant is at a Medicaid Qualifying level.

Sometimes you will see that Medicaid resource level for spouse is a range $74,820 - $154,140. If on the day of admission, the total amount of resources when divided by two is more than half, then the spouse is allowed more than $74,820 up to the $154,140.

What Counts as a Resource?

• Any financial account with a value in the name of resident, or spouse. IF THERE IS AN ACCOUNT – IT MUST BE TRACKED AS EITHER PART OF THE NAMI OR AS A RESOURCE. Resources are tracked on the first day of the month you are seeking coverage for – before income goes in.
• For purposes of Medicaid, unless detailed verification is provided otherwise, any account that your resident’s or spouses name is found on is considered by Medicaid as belonging to that individual. The burden of proof is on you to prove that it is not the residents.

Ex. Grandparents that hold bank accounts with grandchildren, saving bonds, or NYS 529 Plans – these are considered the resident or spouses – NOT the grandchildren. This also applies to joint accounts with children – only way the account is exempt is if the child’s income is deposited into the account monthly.

Some Examples of Countable Resources Are:

• Bank Accounts – Checking/Savings/CD’s/Credit Unions
• Mutual Funds/Brokerage Accounts/NY 529 Plans
• Stocks
• Life Insurance
• Cars/Boats/ATV’s
• Bonds
• IRA/Annuities not having a distribution – if a distribution is started then it is considered income. IRA/Annuities are complex – do you want them as a resource or income
• 2^nd Property/Time Share/Condos

Important Points:

If an applicant has a Life Insurance policy that has a Cash Value that is larger than Medicaid allowed amount than the applicant will probably be over resourced until that policy is surrendered, and resident pays privately.