Last week, the New York Times reported that over 350,000 New Yorkers have obtained health care coverage with private insurers on the New York exchange. The Times mentioned Metroplus, an extremely popular plan, which is run by the New York City hospital system. For more information on the various types of health care insurance packages available though Metroplus, visit its website at www.metroplus.com.

Of course, as was expected, Medicaid enrollments have increased and, in all likelihood, will continue to do so as enrollment deadlines do not apply to Medicaid.

Expanded Medicaid Enrollments and Eligibility

As we have more and more Medicaid enrollees, and even more are expected to join the rolls in the short term, let’s look at Medicaid eligibility with respect to assets, that is, both income and resources. When evaluating an application, Medicaid examines the applicant’s income (money received from a wide variety of sources, on a monthly or quarterly basis, such as pensions or IRA distributions) and resources (property both real and personal, such as a home or bank account) in the possession of the applicant at the time the application is submitted.

Medicaid views assets as either exempt or non-exempt, be they income or resources. Exempt assets are excluded when evaluating an applicant’s eligibility, and non-exempt assets are considered. Exempt resources include the homestead, and the personal property therein, an automobile, funeral and burial accounts, war reparations and $14,550.00 in cash or the like. Be aware that any monies received as a result of war reparations must be kept separate and apart from other resources. Commingling will cause the war reparations to be considered non-exempt and will affect eligibility.

Monthly income of $809.00 is considered exempt. Any income received in excess of that amount will trigger a spend-down or total denial, depending on the amount with respect to the applicant’s medical expenses. Certain income is considered temporarily exempt, such as tax refunds, retroactive Social Security retirement or disability payments, earned income credit payments or Crime Victim’s Assistance fund payments. Those sources of income are exempt in the month received and continue to be considered exempt resources for nine months thereafter.

If, after that time period, the Medicaid recipient still possesses those monies, then that resource will be considered non-exempt and will affect eligibility. Reverse mortgage payments are considered exempt in the month received but become non-exempt in the following month, the idea being that one receives reverse mortgage payments to help with monthly expenses and not as a savings tool, like an investment.

What if Medicaid makes a determination that income or resources are no longer exempt? Excess income and excess resources are treated in the same way, here in New York. A Medicaid applicant will receive medical assistance as soon as medical expenses exceed excess income or resources. One can use those medical expenses to spend-down income or resources, but not both simultaneously. Once the excess income or resources have been off-set, then Medicaid benefits will be paid.

The above list is for general information purposes only. It is not intended to constitute individual legal advice or a specific recommendation to any particular client./font>

This publication is intended for general information purposes only. It is not intended to constitute individual legal advice to any specific client.  To unsubscribe or change your email address, please contact Linda L. Kordes at linda@kordeslaw.com.