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By John M. Bigler As many of you are aware from previous articles, the Medicaid Program covers not only nursing home care, but, in New York, provides significant assistance in the community as well. Community Medicaid is available to cover various medical costs including home health aides, adult day care programs, prescriptions, doctors who are enrolled in the Medicaid program, and even hospital stays.
However, there is an alternate type of community Medicaid available. It is known as the Lombardi Program, or "nursing home without walls". The Lombardi Program is specifically designed for those people who require more services at home than a home health aide. The program will provide aides, but in addition, will also provide services such as physical and occupational therapy, skilled nursing care and social work intervention. As the name would indicate, this type of care is typically suited for that person who is on the cusp of needing nursing home care, but, with this type of intensive assistance, is still capable of remaining in the community. As would be expected, there are a number of drawbacks to the Lombardi Program. The first is that unlike traditional community care, the Lombardi Program does have a period of ineligibility if assets are transferred. The period of ineligibility is the same as for nursing home care. A transfer of assets will result in a period of ineligibility based on the amount transferred divided by the average monthly cost of a nursing home. In New York State, at the present time, the period of ineligibility will commence the month after the transfer has been made.
If the spouses on their own have more than $2,019 then they will be asked for a voluntary contribution of 25 percent of the amount over $2,019 a month. Comparing these figures with the figures for a couple in the traditional home care scenario will provide a clue as to why in many spousal situations, the Lombardi Program is preferred for financial reasons. With traditional community Medicaid, an individual is only allowed $604 a month in income. A couple is allowed $870 a month. Anything over and above that, has to be paid for medical expenses. Traditional Medicaid, has no automatic community spouse resource or income allowance. A couple is allowed a resource allowance of $8,100. A couple with relatively limited resources will be required to execute a spousal refusal, whereas with the Lombardi Program, they would not. They will also be able to keep significantly less income than under the Lombardi Program. As an example, John and Mary are a couple living in the community. John is in need of home care services. The couple has a joint account of $50,000. Johnıs monthly income is $1,500 and Maryıs is $700. If John were to apply for traditional home health care, all of the assets would have to put in Maryıs name and she would be required to execute a spousal refusal so as to guarantee the Medicaid application would be solely for John as an individual and not for a couple. John would be approved for traditional home care and the $50,000 would be protected because Mary executed the spousal refusal. However, John would be allowed to keep only $604 of his $1,500 a month income meaning that the couple would have to spend $896 of Johnıs income on medical expenses before Medicaid paid the balance of medical bills each month. Mary would keep her $700 a month and the couple would have a total of $1,304. In the past, Mary would be able to go to Family Court and sue John for additional income, but that is no longer a viable option. However, were John to apply for the Lombardi Program, then Mary would be allowed to keep a total of $2,019 a month in income, meaning that she would could keep $1,419 of Johnıs income and only $81 would have to be spent on medical expenses. Although financially the Lombardi Program could be advantageous for a couple, there are drawbacks. Because the program provides various types of benefits in addition to simply home health aide, the amount of hours for home health aides will be limited. Typically, the Lombardi Program will not provide more than 40 hours a week of home health aides. As noted, there are transfer penalties unless assets are transferred to the spouse. Therefore, there is not the freedom in a Lombardi case as there would be with traditional home care to make transfers into an irrevocable trust or to children directly. However, in the right circumstances, especially for a couple, the Lombardi Program can be a viable alternative to traditional home care. 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 |
As noted previously, one of the significant benefits of community Medicaid is that there are no transfer penalties, meaning that one could transfer any amount of assets and immediately be eligible for community Medicaid. The applicant, as always, is required to list all transfers made within 36 months as part of the Medicaid application, but will not be penalized.
The Lombardi Program also has the same financial requirements as nursing home Medicaid. This can be an advantage over traditional home health care. The spouse of an applicant for the Lombardi Program is allowed a community spouse resource allowance of $80,760 in 1998. The spouse is also allowed a community spouse monthly income allowance of $2,019.