There are two main categories of Medicaid in New York: Community Medicaid and Nursing Home Medicaid. The rules for each are different, and they affect the benefits that may be available to you. While most people have heard of Medicaid’s “five year look back,” they do not realize that, in New York, it only applies to Nursing Home Medicaid. There is no look back for Community Medicaid.
The New York State Department of Health describes Community Medicaid as follows: “[Community] Medicaid pays for a variety of medical services that can help you continue to live in your home, or for special services available to participants in waivers [people with specific disabilities]. Some of the covered services are: doctor and clinic services, prescription and non-prescription drugs, home care, personal care aides, adult day care, lab tests, transportation to medical care, physical, occupational and speech therapy, mental health services, x-rays, durable medical equipment such as wheelchairs, orthotic and prosthetic appliances.”
In New York, Community Medicaid is available to eligible people who are living in their own homes (see “Medicaid Home Care”). It is also available to eligible people who are living in Assisted Living facilities (see “Medicaid Assisted Living“). Eligibility is subject to specific rules, depending on various criteria such as age, marital status, the amount of your assets, and the amount of your income. To find the eligibility rules that govern your specific situation, click here.