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By John M. Bigler As I mentioned in last month's article, the 1996 New York State budget did not change the Medicaid eligibility rule for an applicant requesting home health care pursuant to Medicaid. As with nursing home eligibility, an individual applying for home health care benefits is entitled to have $3,350.00 in resources, plus a $1,500.00 burial fund. There is also a 36 month look-back period in which Medicaid can inquire as to any transfers of assets that the applicant has made.
Since there are no penalties involved for establishing eligibility for traditional home health care, it's therefore possible for an individual to make themselves immediately eligible by simply transferring their assets to another person or into an irrevocable asset management trust. Once the application is approved, which can take two to three months, a visiting nurse will be sent to the home to make a determination as to the medical needs of the applicant, a critical stage in the application process. In the recent past, it was not unusual for applicants to be awarded 24 hour-a-day care. However, due to the recent budget cutbacks, the local offices of the Department of Social Service have been increasingly hesitant to award extended hours of care. If available, the report of the applicant's treating physician will be important in making a determination. One must be careful, however, not to paint too dismal a picture of the applicant's condition. The danger is that Medicaid will withhold any home health coverage on the basis that the individual's condition is such that it warrants institutionalization. In the case where the applicant for traditional home health care has a spouse, there is an ironic twist to the way the law works. Unlike the nursing home scenario where the spouse living in the community would automatically be entitled to a resource allowance of $76,740.00 and a monthly income allowance of $1,919.00, there are no such allowance figures for the spouse living with a Medicaid recipient in their home. A family of two is allowed a total of $7,850.00 in resources which includes two burial funds of 1,500.00 each. The individual receiving assistance is allowed monthly income of $579.00, any additional income attributed to the recipient must be spent down on medical expenses each month. If the spouse with the more significant income is the one who needs Medicaid assistance, there is nothing that the other spouse can do (including a support petition in Family Court) to have any of that income transferred. Even though the ill spouse's resources could be transferred over to the well spouse, the couple is permitted a total resource allowance of only $7,850.00 (as opposed to $76,740.00 in the nursing home situation). This results in a strange situation in that the well spouse is better off financially having their husband or wife institutionalized rather than struggling to provide care at home with traditional home health care. Should the total resources exceed $7,850.00 the well spouse would need to execute a spousal refusal. The spousal refusal allows the well spouse to refuse to contribute any of his or her assets towards the medical care of their spouse. It should be repeated that the Lombardi Program has the same financial guidelines as the nursing home and, therefore, may be a preferable choice in a spousal situation. This is because the client can have the higher resource allowance and the higher income allowance. It is important to fully understand all the aspects of home health care. By doing so, one could make an educated choice in determining whether it is feasible to keep a loved one at home for as long as possible prior to his institutionalization. Reprinted with permission of the Suffolk Times © 1999 [ Contact Us ] [ Guestbook ] [ Email ]  The Law Offices of John M. Bigler, Attorney At Law 1421 Wantagh Avenue, Wantagh, New York 11793-2206 1-888-ELDER-LAW · 516-409-6565 · Fax: 516-409-6522 E-Mail: info@biglerlaw.com · Web Site: www.biglerlaw.com |
Although very little has changed, there is a major distinction has been made between home care and nursing home eligibility. There is no penalty or period of ineligibility attached to a transfer of assets when the application is for traditional home health care which includes the assistance of home health aides according to the needs of each individual. However, if an individual files an application for the Lombardi Home Care Program (also known as "Nursing Home Without Walls"), the same transfer penalty rules as the nursing home application apply to this program because it provides more encompassing care than simply traditional home health care.