am i eligable for medicaid? New York New Jersey

Many of our clients have the opportunity to choose whether they receive long term care services in New Jersey or New York.  For seniors who are impoverished, or conducted elder care planning, Medicaid is the primary government benefit for long term care services. While Medicaid is a federal program, it is administered at the state level.  Therefore, there are often vast differences in how states determine eligibility. Below, I will explain the basic distinctions between New York and New Jersey Medicaid for a single individual. This is not designed to be an exhaustive discussion, but I hope the reader will gain a rudimentary knowledge of how the programs differ and will then seek experienced elder law counsel to discuss options.


Asset Limits (2018)


In order to qualify for Medicaid, New Jersey requires that the applicant have no more than $2,000 in countable assets.  Countable assets include everything, except:  a primary residence with equity not exceeding $858,000; one automobile; various personal possessions; an irrevocable burial trust; and certain Medicaid compliant annuities.


On the other hand, New York requires that the applicant have no more than $15,150 in countable assets.   In addition to New Jersey’s list of exempt assets, New York does not count individual retirement accounts (“IRA”) under certain circumstances. If the IRA belongs to the non-applicant spouse it is not counted. Also, the IRA is not counted if the applicant has elected to receive periodic payments rather than retaining the ability to take IRA assets at will.  If the applicant is younger than 59 ½ the IRA is not an available resource and is exempt.


Income Limits (2018)


New Jersey is an income cap state but allows those with excess income to fund a Qualified Income Trust.  The income cap is $2,250 per month. If the applicant’s income exceeds that cap, she must fund a Qualified Income Trust with the entire income source that caused the excess income.  This is a complicated solution to a simple problem and should be attempted only with the counsel of a competent elder law attorney.


Likewise, New York has an income cap of $842/month.  Any monthly income in excess of that amount must be spent down on medical or home care services before Medicaid will provide coverage.  Due to this restriction, Medicaid recipients living at home in New York would not be able to afford their monthly living expenses. The solution is to fund a Pooled Income Trust.  A Pooled Income Trust is a trust run by a non-profit to allow Medicaid applicants to become financially eligible for Medicaid home care. Trust income is not counted as available income.  Again, this solution should be attempted only with the advice of a competent elder law attorney.


Look Back Period


Both New Jersey and New York follow the five-year federal look back rule.  In short, the Medicaid agency caseworker will examine financial records for the five years preceding the Medicaid application. The caseworker is looking for transfers meant to impoverish the applicant and qualify her for Medicaid sooner. However, unlike New Jersey, New York does not have a true look back for home care.  This can act as a trap for those Medicaid recipients who later require a higher level of care or move to another state, such as New Jersey.


Medicaid Services Availability


New Jersey’s Medicaid program does not cover as many hours at home.  However, many of New Jersey’s finest assisted living facilities and nursing facilities accept Medicaid.  New York has fewer Medicaid accredited facilities, especially in the assisted living space.


The above distinctions exclude certain differences that are beyond the scope of this article. Furthermore, the two most important criteria for choosing the location in which your loved one will receive care are quality of care and proximity to family members who will visit on a regular basis.


As you can see, receiving Medicaid services for long term care needs is not as simple as running out of money and applying for government benefits.  There are various nuances that must be considered. Consultation with a competent elder law attorney licensed in both New York and New Jersey is imperative to make certain that you or your loved one receives the best care in the right location.