Medicaid Attorneys

Medicaid is a federal and state program that provides health care coverage for qualifying individuals and families, including seniors and people with disabilities. Medicaid covers a range of services, such as doctor visits, hospital stays, prescription drugs, home health care, and long-term care. However, Medicaid eligibility and benefits vary by state, and the rules can be complex and confusing. That’s why you may need the help of an experienced New York elder law firm to guide you through the Medicaid process and protect your rights and assets. 

How Our Medicaid Attorneys Can Help You

Our experienced Medicaid attorneys in our Elder Law Practice Group can help determine the best path toward securing Medicaid benefits for you or your loved one, and craft a personalized strategy based on your individual circumstances, finances, and medical needs. 

Medicaid Planning 

“Medicaid planning” is the process of arranging your income and assets in a way that allows you to qualify for Medicaid benefits while maximizing the preservation of your resources for yourself and your loved ones. Medicaid planning can help you avoid or reduce the risk of losing your home, your savings, your income, and your inheritance to the cost of long-term care. 

Medicaid planning can also help you avoid or minimize the impact of Medicaid recovery, which is the right of the state to seek reimbursement from your estate for the benefits you received. Medicaid planning can involve various strategies, such as transferring assets, creating trusts, purchasing annuities, applying for exemptions, and using spousal protections. Medicaid planning requires careful analysis and professional guidance, as the rules and consequences can be complicated and vary by state and by program.  

Although our Medicaid attorneys can assist clients in addressing Medicaid planning needs in a moment of crisis, when there is an imminent need for home care or nursing home care, the best time to engage in Medicaid planning is at least five years in advance of when you may actually need Medicaid coverage.  It’s never too early to begin the process of speaking with an elder law attorney about the Medicaid planning you can do today to protect your future.  

Medicaid Applications 

Our experienced Medicaid attorneys have a comprehensive understanding of the Medicaid application process and can assist you in preparing your Medicaid application, whether it is for Community-Based Services or Nursing Home coverage through the Medicaid program. We are committed to ensuring not only that our clients have a strong advocate to assist them throughout the Medicaid process, but that they also have a firm understanding of the Medicaid program and how it operates. 

Our team of Medicaid attorneys and support staff will work with you and your family to review your financial information and discuss your eligibility for Medicaid benefits, determine what documents need to be provided in support of your Medicaid application, and guide you through any additional steps that may need to be taken prior to submission of your application to ensure you meet all of the necessary criteria for Medicaid eligibility.    

When there are potential issues that you believe may prevent you from currently qualifying for Medicaid benefits coverage, there are almost always legal strategies that our experienced Medicaid attorneys can implement to help you achieve Medicaid eligibility at the earliest date possible. We can guide our clients through different options to manage excess resources, address problematic transfers of assets occurring during the five-year look-back period, or otherwise manage your assets and income in a way that allows you to preserve your assets, to the greatest extent possible, while establishing your Medicaid eligibility.  There are many creative strategies that our attorneys can use to help individuals who do not believe they are Medicaid-eligible secure Medicaid benefits coverage.

Our Medicaid attorneys can also assist you in navigating the Medicaid application process once your application has been submitted. There are often additional steps needed in order to secure a Medicaid approval while the application is being processed, including providing timely responses to follow-up requests issued by the Medicaid agency reviewing your application.  Engaging one of our experienced elder law attorneys to help navigate the Medicaid program early in the process ensures that you will not be left to figure out your next steps, with a “ticking clock” imposed by the Medicaid agency, when it seems impossible to secure the requested documentation and submit it to the agency before the deadline.  Our attorneys also know how to assert certain rights that applicants have during the Medicaid application process to ensure that you are treated fairly throughout the processing of your application.  

The Medicaid attorneys at our firm also have extensive experience in addressing complex Medicaid eligibility issues that require a higher level of legal skill and advocacy, and have achieved successful outcomes for clients at Fair Hearings and through other levels of appeals, including reversals of wrongful denials of Medicaid applications and reduction or withdrawal of penalty periods imposed due to transfers of assets during the lookback period. In cases involving an incapacitated person who cannot engage in the Medicaid application process without assistance, our firm frequently assists clients in pursuing legal guardianship through the courts in order to secure the appointment of a Guardian who can take the steps necessary to complete the Medicaid application process and secure Medicaid benefits for their ward.  The unique experience and expertise that our Medicaid attorneys have in these areas allow us to fight for our clients’ rights at every stage of the Medicaid application process and employ creative strategies tailored to your specific needs and circumstances.

An Overview of the Medicaid Program 

Medicaid is a federal and state program that provides health care coverage for qualifying individuals and families, including seniors and people with disabilities. Medicaid covers a range of services, such as doctor visits, hospital stays, prescription drugs, home health care, and long-term care. However, Medicaid eligibility and benefits vary by state, and the rules can be complex and confusing. That’s why you may need the help of an experienced New York elder law firm to guide you through the Medicaid process and protect your rights and assets.

Community Medicaid

“Community Medicaid” refers to Medicaid benefits that cover home health care and other community-based services for seniors and people with disabilities who need assistance with daily living activities. Community Medicaid can help you stay in your own home or at an assisted living facility, rather than moving to a nursing home.  

Community Medicaid benefits are traditionally administered through either personal care services, home health aide services provided by a licensed agency, or through CDPAP, the Consumer-Directed Personal Assistance Program, which allows a Medicaid recipient to direct the way in which their community-based services are provided. Through CDPAP, a Medicaid recipient can arrange for a caregiver of their own choosing, such as a friend or family member, to provide the care that they need to remain in the community, and for the caregiver to be compensated for their services through the Medicaid program.     

There are also waiver programs, such as the Nursing Home Transition and Diversion (NHTD) Waiver program and the Traumatic Brain Injury (TBI) Waiver program, administered through the Community Medicaid program, which provide significant benefits to individuals in the community who would ordinarily be living in a residential health care facility.

While the same financial eligibility criteria applies for both Community Medicaid and Nursing Home Medicaid applicants, currently, in New York, there is no “look back” period for Community Medicaid, meaning that the financial eligibility determination is based on a “snapshot view” of what your financial resources are as of date of your Medicaid application. This means that, under most circumstances, a person who does not qualify for Community Medicaid today can engage in Medicaid planning, with the assistance of an elder law attorney, and become financially eligible for Medicaid the following month.  

Nursing Home Medicaid

Nursing Home Medicaid (or Institutional Medicaid) refers to Medicaid benefits that cover or contribute toward the cost of nursing home care for seniors and people with disabilities who need skilled nursing care and supervision.  

When a person is deemed eligible for nursing home Medicaid benefits, their financial contribution toward their nursing home care is typically limited to the amount of their monthly income, as calculated by the local social services district overseeing the benefits program. A recipient of nursing home Medicaid benefits is permitted to keep $50 each month from their monthly income, which they may spend on anything they would like, and the remainder is budgeted as the recipient’s Net Available Monthly Income, or “NAMI”. The individual’s NAMI must be paid, in full, to the nursing home each month, while the Medicaid program contributes the remainder of the cost of care to the nursing home. If a person has assets over the Medicaid resource allowance threshold, he or she may need to “spend down” their excess resources before Medicaid benefits can begin to cover the cost of their care.

A major difference between the Community Medicaid and Nursing Home Medicaid programs is the five-year “look back” period that applies to Nursing Home Medicaid applicants. For individuals seeking nursing home Medicaid, in addition to demonstrating that they meet the current financial eligibility requirements at the time of the application submission, they must also provide financial records for the five-year period immediately preceding their admission to the nursing home. As part of the Medicaid application review process, the local social services district will look at your income and asset history for the past five years to see if you have transferred or given away any of your resources to avoid paying for your care. A finding that a Medicaid applicant has performed these uncompensated transfers of assets during the five-year look-back period can result in a penalty period during which the Medicaid program will not contribute toward the cost of care in the nursing home. If a penalty period is assessed, this means that you will be personally responsible for contributing more toward the cost of your care in the nursing home from your own financial resources.

While the Medicaid program presumes that any uncompensated transfer of your assets performed during the five-year look back period was made for the purpose of qualifying for Medicaid benefits, our attorneys have assisted clients in rebutting this presumption by providing evidence that the transfer of assets was performed exclusively for a purpose other than qualifying for Medicaid benefits. There are also some transfers of assets that are “exempt” under Medicaid rules and regulations that will not result in the imposition of a penalty.        

It is important to review your financial information with an experienced elder law attorney, who can examine your transaction history and determine whether there are any problematic transfers of assets during the five-year look-back period, and help you to address them proactively in the context of the Medicaid application process.

How Do I Know if I Qualify for Medicaid Benefits?

In order to qualify for Medicaid benefits, an individual must demonstrate that they have a medical need for assistance and that they meet the financial eligibility requirements for Medicaid benefits.   

In New York, the New York State Department of Health issues updated information each year regarding the financial eligibility requirements for Medicaid and other benefits programs.  These figures include the permissible allowance of assets and income that a person may have while qualifying for Medicaid benefits.  

The current New York asset and income allowance threshold amounts for Medicaid eligibility in 2025 are as follows:

For more information regarding the current eligibility criteria and government benefit rates for 2025, click here.

When determining your total “countable resources” to see if you are financially eligible for Medicaid benefits, it is important to note that not all of your assets are counted when evaluating your Medicaid eligibility.  There are a number of assets that are either disregarded, deemed “exempt”, or treated differently than other assets in the context of the Medicaid eligibility analysis.  Some examples of these assets include:

• A person’s home, which may be deemed “exempt” if it qualifies as the person’s “homestead” (their primary residence, which the individual intends to return to if currently receiving care in a nursing home); 
• A vehicle, if it is in use;
• An irrevocable pre-need funeral trust account, which sets aside funds to be used for your final expenses; and
• Retirement accounts, which are disregarded as assets, provided that they are in payout status (and the income is instead counted as part of the Medicaid budget).

If a person’s total financial resources exceed the permissible resource allowance threshold, they are deemed to have “excess resources” which must be “spent down” on the cost of their care before Medicaid will begin to cover these expenses. There are also certain other legal planning techniques that can be used to reduce an individual’s total countable resources to allow a person to become Medicaid eligible. 

If a person’s income exceeds the permissible Medicaid income allowance threshold, depending on what type of Medicaid benefits coverage they are applying for, an applicant may be required to contribute their income toward the costs of their care before the Medicaid program will contribute payment toward these costs. 

In the alternative, in the Community Medicaid program, they may be permitted to divert their “excess income” to a pooled income trust, which will allow them to use these funds to pay their monthly bills (for non-Medicaid covered services). An experienced Medicaid attorney can assist you in reviewing your assets and income to determine if the use of a pooled income trust, or one of these other Medicaid planning strategies, may be advisable based on your circumstances.   

What Can I Do If I Have “Too Much Money” for Medicaid?

If you have too much money to currently qualify for Medicaid benefits, you may think that you have no choice but to pay for your long-term care out of pocket, or to deplete your income and assets until you become eligible. However, this is not necessarily the case. There may be ways to legally and ethically reduce your income and assets, or to protect some of your resources from Medicaid, without jeopardizing your eligibility or your quality of care. For example, you may be able to use a pooled income trust, a supplemental needs trust, a Medicaid asset protection trust, or a “spousal refusal” to qualify for Community Medicaid. You may also be able to use a Medicaid-compliant annuity, a promissory note, a personal care contract, or a gift-and-loan strategy to qualify for some forms of Medicaid. These are just some of the options that may be available to you, depending on your specific situation and goals. To find out more, our knowledgeable and experienced New York elder law attorneys can help you plan and apply for Medicaid in the most beneficial way possible.

Get Started with Guidance from a Trusted Medicaid Attorney

Please contact us today to speak with our experienced Elder Law attorneys if you have questions regarding government benefit rates, Medicaid eligibility, or any other elder law needs!