Contributed by: Dan Rose
As a Queens, NY trusts and estates attorney, I often help families navigate the Medicaid system when long-term care becomes necessary. Whether a loved one needs help at home or full-time nursing home care, understanding New York’s Medicaid rules is critical. The process can be confusing, and small mistakes can lead to denials, delays, or loss of benefits. With the right guidance, however, families can secure care while protecting as much of their savings as possible.
Difference Between Home Care and Nursing Home Medicaid
New York offers different Medicaid programs depending on where care is provided. Nursing Home Medicaid is an entitlement program, meaning that if you qualify, benefits must be granted if you qualify financially. Home Care Medicaid, provided through Managed Long-Term Care (MLTC) plans, is also an entitlement program if you qualify both financially and clinically.
Community-based Medicaid allows eligible individuals to remain at home while receiving help with daily activities such as bathing, dressing, and meals. Many families prefer this option, but it requires early planning and a clear understanding of eligibility rules. In my work with families throughout Queens and New York City, I often stress that identifying the correct program early is a key part of effective elder law planning.
Financial Eligibility
Medicaid eligibility is based on both income and assets, with limits that are adjusted periodically by the state. For single applicants seeking nursing home coverage, income must generally fall below a modest monthly threshold, and countable assets must be limited to a relatively small amount. All sources of income are included in the assessment, such as: Social Security, pension payments, and retirement account distributions.
Married applicants benefit from important safeguards designed to protect the spouse who remains in the community. New York allows the non-applicant spouse to retain a substantial portion of the couple’s combined assets and, in many cases, to receive additional income from the applicant spouse if their own income is insufficient. These protections are intended to prevent the community spouse from experiencing financial hardship.
Key financial concepts include:
- Income rules: All monthly income is applied toward the cost of care once eligibility is established
- Personal allowance: Nursing home residents are permitted to keep a small monthly amount for personal expenses
- Spousal protections: Special rules apply when one spouse applies and the other remains at home
Because the exact limits change regularly, families should confirm current thresholds before taking action.
Asset Transfers and the Look-Back Rule
New York applies a 5-year look-back period for nursing home Medicaid. During this time, Medicaid reviews financial transactions to see if assets were gifted or sold for less than fair value. If so, a penalty period may apply, delaying eligibility.
The length of any penalty depends on the value of the transferred assets and the average cost of nursing home care in the state. Given the high cost of Institutional care in New York, even relatively modest transfers can lead to significant periods of ineligibility.
At present, home care Medicaid has a 30 day look back period, although changes to this rule have been discussed and may be implemented in the future. This uncertainty makes proactive planning especially important.
Emergency Planning With Promissory Notes
When a loved one needs immediate nursing home care and no prior planning was done, families may still have options. One commonly used strategy in New York is Medicaid planning with promissory notes, sometimes called the “half-a-loaf” approach.
In simple terms, this method:
- Involves gifting part of the applicant’s assets to family
- Uses the remaining assets to create a promissory note that pays for care during the penalty period
- Can help preserve roughly half of the family’s savings, even after nursing home admission
This approach is legally recognized in New York, but it must be done precisely. Families considering Medicaid planning with promissory notes should work closely with an experienced attorney.
Advantages include:
- Meaningful asset protection
- Availability of benefits during crisis situations
- Established legal support in New York
Potential risks include:
- Strict timing and calculation requirements
- Income complications if structured incorrectly
- Extensive documentation obligations
Applying for Medicaid
Medicaid applications require detailed paperwork, including proof of identity, income, assets, and financial history. Applicants must submit bank records, retirement account statements, insurance policies, and documentation of past transfers.
For Queens residents, applications are handled through the local Department of Social Services or the NY State of Health system. Because errors are common and costly, many families choose to work with an elder law attorney to ensure the application is accurate and properly timed.
Planning Ahead Protects Your Family
The best Medicaid outcomes come from early planning, ideally five years or more before care is needed. Still, even in urgent situations, legal strategies can help preserve assets while securing quality care. Families facing long-term care decisions in New York should seek professional guidance to understand their options and protect their future.
Contributed by: Dan Rose, A Senior Local Business Guide Specializing in New York Estate and Probate Laws.
At The Law Offices of Roman Aminov, we’re committed to protecting your future and your family with clarity, compassion, and care.
Visit us at https://www.aminovlaw.com/ to book a free consultation today.
Get Directions Below!
Law Offices of Roman Aminov, 147-17 Union Tpke, Queens, NY 11367, (347) 766-2685
