Community Medicaid and Home-Care Services in New York
Community Medicaid and Home-Care Services in New York
Many older adults and people with disabilities want to remain safely in their own homes but need help with everyday activities.
New York’s Community Medicaid program may help eligible individuals receive healthcare and long-term-care services while continuing to live at home or in another community setting.
Hudson Valley Medicaid Planning helps families understand eligibility, organize financial documentation, prepare Medicaid applications, and navigate the steps involved in requesting home-care coverage.
What Is Community Medicaid?
Community Medicaid provides Medicaid coverage to eligible New York residents who live in the community rather than permanently residing in a nursing home.
Depending on the person’s eligibility and assessed needs, coverage may include medical services and community-based long-term care.
Community Medicaid is different from nursing-home Medicaid. The financial, application, assessment, enrollment, and service-authorization requirements can vary.
What Services May Be Available?
Depending on the program, medical need, assessment, and plan authorization, available services may include:
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Personal-care assistance
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Help with bathing, dressing and toileting
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Assistance with eating and mobility
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Meal preparation
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Light housekeeping
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Medication reminders
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Home-health services
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Nursing services
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Physical or occupational therapy
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Medical equipment and supplies
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Transportation to covered medical appointments
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Adult day healthcare
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Other approved long-term-care supports
Medicaid approval does not automatically guarantee a particular service, provider, schedule, or number of home-care hours. Services must be medically necessary and authorized through the appropriate program or managed-care plan.
Who May Qualify?
Community Medicaid may be available to New York residents who meet the applicable financial and program requirements.
Eligibility may depend on:
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Age or disability status
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New York residency
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Monthly income
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Countable resources
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Marital status
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Living arrangements
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Existing health-insurance coverage
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Medical and functional needs
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The type of services being requested
Financial approval for Medicaid and authorization for home-care services are separate steps.
What If the Applicant’s Income Is Too High?
Having monthly income above the Medicaid limit does not always prevent eligibility.
For certain applicants who are disabled, excess monthly income may be deposited into an approved pooled income trust. The trust can then use the deposited funds to pay approved personal expenses on the Medicaid recipient’s behalf.
A pooled trust must be properly established, submitted, accepted and maintained. Required deposits should be made each month according to the person’s approved Medicaid budget.
What If the Applicant Has Too Much in Savings?
Medicaid reviews countable resources such as bank accounts, investments and certain other assets. However, not every asset is treated the same way.
The treatment of a home, vehicle, retirement account, life-insurance policy or other property depends on the applicant’s circumstances and applicable Medicaid rules.
Do not gift, transfer, retitle or dispose of assets solely to qualify for Medicaid without first receiving individualized guidance. Transfers may create Medicaid, tax or legal consequences.
How Does the Home-Care Process Work?
The process may include several separate steps:
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Financial eligibility review
The applicant’s income, resources, insurance coverage and household circumstances are reviewed. -
Medicaid application
The required application, supplements and supporting documents are submitted to the appropriate Medicaid agency. -
Medical and functional assessment
An assessment determines whether the applicant requires assistance and qualifies for community-based long-term-care services. -
Plan selection and enrollment
Some applicants who require ongoing long-term care must select a Managed Long-Term Care plan or another appropriate program. -
Plan assessment and service authorization
The selected plan evaluates the applicant’s needs and determines which services and hours it will authorize. -
Care begins
Services begin after eligibility, enrollment, provider arrangements and authorizations are completed.
New York generally requires people seeking certain ongoing community-based long-term-care services to be assessed as needing those services for more than 120 days. New York State MLTC information
What Is Managed Long-Term Care?
Managed Long-Term Care, commonly called MLTC, coordinates long-term-care services for eligible individuals who need ongoing help while living in the community.
An MLTC plan may coordinate services such as personal care, home care, medical equipment and certain therapies. The plan assigns a care manager and determines the services and hours it will authorize based on the member’s assessed needs.
Receiving a Medicaid card alone does not mean home-care services have already been approved.
Does Medicare Still Provide Coverage?
For individuals who have both Medicare and Medicaid, Medicare generally remains the primary coverage for Medicare-covered services.
This may include:
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Doctors and specialists
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Hospital care
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Prescription-drug coverage
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Short-term skilled home healthcare
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Certain therapy services
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Medicare-covered medical equipment
Medicaid may cover qualifying services that Medicare does not cover or assist with certain remaining costs, depending on the person’s coverage.
Documents You May Need
Applicants should begin gathering:
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Identification and proof of New York residency
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Social Security and Medicare cards
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Health-insurance information
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Social Security and pension verification
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Bank and investment statements
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Retirement-account statements
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Life-insurance information
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Property information
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Marriage or spousal information, if applicable
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Current medication list
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Medical records and physician information
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Existing home-care schedules
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Powers of attorney or authorization forms, when applicable
Additional documents may be required based on the applicant’s finances and circumstances.
How HV Senior Advocates can help!
We assist New York families with:
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Preliminary eligibility screenings
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Income and resource reviews
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Medicaid application preparation
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Financial-document organization
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Pooled income trust coordination
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Spend-down guidance
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Responses to requests for additional information
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Communication throughout the application process
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Guidance on the next steps after approval
Find Out Whether Community Medicaid May Help
If you or a loved one needs assistance at home, you do not have to navigate the Medicaid process alone.
Start with a free screening so we can better understand the applicant’s income, resources, care needs and current coverage.
Prefer to speak with someone?
Call (329) 234-3711
Serving families throughout Ulster, Dutchess, Orange, Sullivan, Greene and surrounding New York counties.
Hudson Valley Senior Advocates provides Medicaid planning and application support. We do not provide legal, tax or investment advice. Matters involving trusts, deeds, asset transfers or other legal strategies should be reviewed by a qualified New York elder-law attorney.