How to Apply for Medicaid in NY: A Comprehensive Guide

apply for medicaid ny

Applying for Medicaid in New York State driving you nuts? You’re in the right place. Fighting through all the red tape can be confusing, but we’ll make it easy with this handy how-to guide.

We’ll walk you through everything required to successfully apply and get approved. No jargon, just straightforward advice on:

  • Types of Medicaid for long-term care
  • Eligibility requirements
  • Speeding up determinations, and
  • How to get help

Whether you’re collecting pay stubs or decoding eligibility letters, we have you covered. Follow along for pro tips to get affordable coverage fast. 

Know the Different Types of Medicaid

Medicaid programs fall into different categories depending on the type of coverage offered. New York has several distinct Medicaid offerings for its residents in financial need. 

Getting familiar with the unique purposes of each form of Medicaid will allow you to identify the optimal program for your personal situation.

Nursing Home/Institutional Medicaid

New York’s nursing home Medicaid program provides comprehensive long-term care coverage for financially limited seniors. It pays for daily assistance with activities like bathing and dressing, skilled nursing, doctor visits, medications, and more. Recipients must contribute most of their monthly income but can keep $50 as a personal allowance. 

Not every facility accepts Medicaid, though spots are guaranteed by law for eligible applicants. Those wanting to eventually transition home from the nursing facility can get Medicaid help arranging services through Money Follows the Person. This crucial program makes nursing home care accessible when there are no other options.

NY’s Community Medicaid

New York’s Community Medicaid helps financially limited seniors get long-term care at home instead of needing a nursing facility. It covers in-home services like:

  • Nursing visits
  • Adult day programs
  • Modifications to make living easier
  • Emergency response systems, and 
  • Hands-on help with daily tasks

Beneficiaries must require a high level of care but be able to remain in the community. There are two main programs – Managed Long Term Care (MLTC) and Assisted Living Program (ALP). 

Managed Long Term Care (MLTC)

MLTC serves those living in their own home or with family. It’s an entitlement, so anyone meeting eligibility is guaranteed enrollment without waiting. Benefits are provided through a Medicaid-managed care plan, which can assign caregivers or let recipients hire their own using a self-direction option. Family, excluding spouses, can be hired this way.

Assisted Living Program (ALP)

ALP helps cover room, board, and care services for those in specific licensed assisted living facilities. These “assisted living programs” are typically special units within larger adult homes providing supervision for 5-200 residents. 

Applicants have to have higher income limits to qualify for ALP’s room and board assistance. If their income is too low, the state supplements it so they can afford to live there. However, ALP does have enrollment caps, so eligible applicants go on a waitlist once yearly spots fill up.

Disabled, Aged, or Blind Medicaid

In addition to regular Medicaid, New York offers the DAB Medicaid program specifically for those who are disabled, over 65, or blind. Also known as “regular Medicaid for seniors,” it provides health coverage plus long-term care support to eligible residents living at home or in the community rather than in a care facility.

As an entitlement, applicants who meet DAB criteria are guaranteed enrollment without waiting. They receive, at minimum, basic Medicaid medical benefits. 

Those showing need can also get some level of at-home long-term care assistance through two attached programs – Community First Choice Option (CFCO) and Program of All-Inclusive Care for the Elderly (PACE).

Community First Choice Option

CFCO delivers services like home health aides, meal delivery, transportation, and hands-on help with daily living activities to those requiring substantial care. Recipients can choose to self-direct these benefits and hire friends, family members, or preferred caregivers.

Program of All-Inclusive Care for the Elderly

PACE provides fully integrated medical care and in-home support for the frailest seniors, coordinating all Medicaid and Medicare benefits into one comprehensive plan. Participants must qualify for nursing home level care but live at home using resources of the PACE day centers.

Am I Eligible for Long-Term Care Medicaid in New York?

Medicaid eligibility is based on factors like age, income, living situation, and the type of Medicaid coverage you’re applying for.

To qualify for Medicaid in New York, you must meet financial and functional requirements.

Financial Criteria

  • For 2024, the asset limit is $30,182 for an individual and $40,821 for a married couple, with both applying. Some assets like retirement accounts and cash are counted. Your primary home is often exempt.
  • The monthly income limits range from $1,732 for an individual up to $2,351 for dual applicants. Most recurring income sources are counted.
  • Some programs like Assisted Living have higher income limits.

Functional Criteria

  • You must require nursing home-level care. New York uses an assessment tool that considers your ability to complete daily living activities and cognitive status.
  • For long-term care services, you’ll undergo an assessment of your capacity for daily living activities. Criteria vary by specific programs but are rigorous, given the at-home nature.

Other Key Medicaid Rules

  • New York looks back five years at financial records to prevent assets from being gifted away right before applying.
  • After death, New York seeks reimbursement from recipients’ estates, but there are planning options to protect assets.

Overall, the criteria aim to provide Medicaid to those truly in financial need while preventing those above cutoffs from quickly impoverishing themselves to qualify. Assessment of care needs ensures recipients truly require coverage of nursing or in-home resources.

Can I Get Medicaid if My Income Exceeds the Limits?

Even if your household makes too much to quality based on the income charts, you still may be eligible for Medicaid. Applicants can leverage high medical bills through the Medicaid Excess Income Program to meet eligibility thresholds.

Seniors, disabled, and blind applicants may also qualify for Medicaid through special considerations despite excess assets or resources.

Finally, the Family Planning Benefit Program provides coverage just for birth control and reproductive services if broader Medicaid qualifications can’t be met due to excess earnings or resources.

Your best bet is to consult a Medicaid planning attorney to understand all options available if your income or assets exceed standard eligibility limits. The right advisor can help you creatively structure your finances to help you qualify.

How Long Does a Medicaid Application Take to Get Approved?

So, you’ve applied for Medicaid and are awaiting your eligibility decision. How long does it take to get that approval or denial notice in the mail?

Here are the standard processing timelines once you successfully submit your complete Medicaid application:

  • 45 days for general applicants
  • 30 days for pregnant women and children
  • 90 days if disability determination required

The countdown starts from the day you properly file for Medicaid, whether through the NY State of Health Marketplace or your local county office.

Approvals for vulnerable groups are expedited, with determinations within a month. Disabled applicants may wait up to 3 months since more assessment is involved.

But rest assured, you’ll get an answer – yes or no – on your eligibility within 90 days at max. You can contact your Medicaid caseworker to check your status if you don’t receive notice by the expected time period.

Get Help Qualifying for Medicaid in NY

Trying to navigate Medicaid eligibility on your own can be incredibly confusing and frustrating. Application denials or coverage gaps can have devastating health consequences.

That’s why partnering with an experienced Medicaid planning attorney is so valuable.

The compassionate team at The Browne Firm have helped countless New York families qualify for Medicaid through:

  • Income restructuring to meet limits
  • Asset protection strategies
  • Irrevocable trusts creation
  • Excess income program guidance
  • Family planning program connections

With an office conveniently located in New York City, we have spent years mastering the intricacies of Medicaid law. Let us review your unique situation and advise if coverage options exist even if you exceed standard eligibility thresholds.

Don’t leave it to chance – get the affordable healthcare you deserve and peace of mind knowing your assets are protected. Contact us today.


Author Bio

Danielle Browne is the founder and managing attorney of The Browne Firm, a New York-based estate planning and business law firm. Danielle leverages her background, serving as general counsel for a Fortune 500 company and working with startups to represent clients in entity formation, intellectual property protection, contract drafting, estate planning, and more.

With more than ten years of experience as an attorney and business executive, she has represented clients ranging from entrepreneurs and small businesses to artists and Fortune 500 companies. Danielle received her Juris Doctor cum laude from the University of Miami School of Law and is licensed to practice in New York. She has received numerous honors for her work, including being named a 2015 Future Leader by the WNBA President while serving as general counsel for the Atlanta Dream.

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