Considering Medicaid If You’re Under 65

Nursing home Medicaid requires recipients to either be over the age of 65 or blind or disabled. Unfortunately, an increasing number of families are searching for long-term care while the recipient is still below the age of 65. Many of these individuals are just a few years short of 65 but have already experienced serious medical conditions like Alzheimer’s disease, strokes, or traumatic brain injuries. Unfortunately, the circumstances that lead a person to require long-term care are not always predictable. If you’re under 65 and interested in utilizing Medicaid, there are some important issues that you should consider.


Nursing Home Is a Valid Option for Someone Under 65


If a Medicaid applicant is below the age of 65, they have the option of establishing that they are disabled to qualify. Verification of disability involves “prima facie” evidence and might include disability determination by the Social Security Administration, disability determination by the Railroad Retirement Board, or proof of receipt of Medicaid benefits. 


Medicaid applicants can provide verification of this data by submitting their disability award letter, proof about Social Security disability income, or confirmation of Railroad Retirement disability income. The applicant also might provide a copy of his or her Medicaid card, which permits the Department of Family and Children Services to process a Medicaid application without obtaining additional disability details. 


New York Medicaid Income Limits


If you are either over the age of 65 or disabled, you can qualify for Medicaid if your monthly income in 2018 was at most $842 for a one-person household and $1,233 for a couple. 

Remember, New York’s Excess Income Program permits individuals to qualify for Medicaid by spending down their income on qualifying medical expenses until they qualify for Medicaid income limits. New York also has a program that lets people pay extra income to the Department of Social Services to maintain Medicaid eligibility. 


What if You Rely on that Individual to Provide Family Support


Diversion of income is allowed when a Medicaid recipient who has either a spouse or dependent lives in a nursing home or institutionalized care center. The amount that can be diverted is based on either the Community Spouse Maintenance Need Standard or the Dependent Family Member Maintenance Need Standard. These figures change yearly.


To qualify as a dependent, a family member must fall within an acceptable degree of relationship. This degree can be either a relationship to the recipient of the diverted income or to the community spouse and is restricted to only minor children, dependent children, dependent parents, dependent siblings, and dependent half-siblings. Additionally, the family member must have been claimed as a dependent on either the most Internal Revenue Service tax return and have income less than $794.00 to be categorized as financially dependent. 


Contact an Experienced Elder Law Attorney


Navigating issues associated with Medicaid can be challenging, but fortunately, an experienced elder law attorney can help you navigate this process. Do not hesitate to contact Ettinger Law Firm today for assistance.

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