Medicaid is a major provider of home care services in New York State through the personal care aide program. A Medicaid application is often triggered by the need for home care by a person who is no longer able to function independently.

Under the Medicaid Home Care Program, personal care aides provide unskilled services under the supervision of nurses. Medicaid provides these services via home care agencies which ultimately provide the licensed personal care aides.

Personal care aides are authorized to provide “hands on” services as well as chore services. “Hands on” services include bathing, toileting, grooming, transferring to or from a bed or chair, feeding and dressing. A personal care aide is not authorized to give medication, or take temperature or blood pressure. Chore services that a personal care aide may perform are housekeeping, laundry, meal preparation and shopping.

Further, the Medicaid Home Care Program can cover hospital care and physician services.

Medicaid Planning

Often times, planning is necessary to make an individual eligible for assistance through the Medicaid Home Care Program. In order to be eligible, you must have less than $13,800 in your name. However, certain assets, such as your residence, are exempt. Applicants for Medicaid should also be aware that even though the residence may be exempt for eligibility purposes, after you die, Medicaid can make a claim against your home (subject to certain exceptions).

The good news is that there is no penalty for the transfer of assets under the Medicaid Home Care program. What this means is that assets can be transferred today and the transfer will not be counted against you if you apply for Medicaid home care the following month. Note that there is still a transfer penalty rule for nursing home care.

If you are married, you can also take advantage of the Spousal Allowance rules. There is no fixed minimum level of income or resources allowable to a well spouse when an ill spouse applies for Medicaid Home Care and the well spouse signs a spousal refusal. Therefore, assets can be transferred to the well spouse from the ill spouse and with spousal refusal, the ill spouse is Medicaid eligible for home care the following month.

Applying for Medicaid

Now, applicants should not rush to file for Medicaid without a full understanding of the income budget rules. The Medicaid recipient is entitled to retain monthly income of only $767 per month, plus $20 if he or she is 65 or older or disabled. Medicaid will pay for any medical bills in excess of the overage amount above $767, plus $20, if applicable.

So, you would not want to apply for Medicaid until the cost of home care services exceeds your monthly excess income. For example, if you are age 70 and have a monthly income of $2,787, Medicaid will pay for unpaid medical bills above $2,000 each month (i.e., $2,787 - $787 = $2,000). This means that it does not pay to file for Medicaid if your medical expenses covered under the Medicaid Home Care program do not exceed $2,000 in this example.

Medicaid Can Be A Life Saver

The Medicaid Community Based Home Care Program can be the difference between receiving necessary care or not receiving that care at all. This goes to the heart of one’s quality of life. If you are not accessing these services that you desperately need, take the first step and discuss your situation with an elder law attorney who can advise you as to what is best for you.