NOTE: Community Medicaid rules changed with the NY State Budget that was passed in April 2020. The new rules are in the process of being implemented. The most significant change is the implementation of a new, 30-month “look back” that is currently scheduled to go into effect for Medicaid applications filed on or after April 1, 2021. We will add an updated video as soon as possible. You can find a brief outline of the changes here.
Many people are unaware that there are two kinds of Medicaid in New York:
Community Medicaid and Institutional (Nursing Home) Medicaid.
It’s important to understand the differences.
Institutional Medicaid is for persons who require long-term custodial care in a skilled nursing facility. The program pays all the costs of the Nursing Home, as well as medical care.
Community Medicaid is for those who can be cared for safely at home or in an assisted living facility. The typical Community Medicaid recipient is someone who needs assistance with performing activities of daily living, such as bathing, toileting, dressing, transferring, and eating.
Community Medicaid includes medical care, as well as other benefits such as Adult Day Care, transportation to and from the doctor, and many other special programs.
If you have Medicaid, you do not have to give up your Medicare and you will probably want to have both.
Different Applications – THE VIDEO IS OUT OF DATE. THE BELOW INFORMATION IS CURRENT
The two programs have different eligibility requirements. The main difference is in the “look back” rules between the two programs. Institutional Medicaid has a 5-year “look back” for transfers. Community Medicaid has a 30-month (2 1/2 year) “look back” for assets that were transferred on or after October 1, 2020. The Community Medicaid look back is currently scheduled to go into effect on April 1, 2021.
I’ll discuss the “look back” in another video.