What Is the Medicaid Application Process in New York?

Medicaid is a program that has a wide range of benefits that are geared towards specific groups and their healthcare needs. However, the program also has different eligibility requirements for the type of Medicaid that is being applied for. In terms of who can apply to Medicaid, the program in general is open to those within a low income bracket in need of healthcare services. This broad population is then broken down into groups with different medical care needs. In the state of New York, these groups include individuals who are pregnant, guardians of a child who is 18 years of age or younger, blind, disabled or have a family member who is disabled, or 65 years of age or older. In addition to belonging to one of these groups, those applying to Medicaid must also meet the program’s annual household income and asset limit. Medicaid is a far-reaching program; however, the eligibility requirements are designed to be highly specialized in order to serve those individuals who need the program the most.

The state of New York provides different ways for individuals 65 years of age or older to apply to the Medicaid program. First, a person may apply in person at the Department of Social Services (DSS) office. Seniors should apply at the DSS office within their county of residence. Seniors may also call the office and apply over the telephone. Online applications are also available through the New York State of Health website. Because certain aspects of the Medicaid application can be difficult to navigate, there are resources available that provide assistance with the application process. Prospective applicants in New York may call the Medicaid Helpline at 1-800-541-2831. Additional information is also available through the New York Medicaid website.

When it comes to applying for Medicaid, the first step in the process is to make sure an applicant meets all eligibility requirements, in particular those that pertain to income and countable assets. This is extremely important as individuals who apply to Medicaid and are found to have made a gift or asset transfer in order to meet the program’s income or asset limits may face a penalty period in which they will be ineligible for Medicaid benefits. It is also important to consider what type of Medicaid an individual wishes to apply for. This will be determined largely by the healthcare needs of the applicant. For example, seniors who wish to live at home but still require regular medical check-ins would apply to Home and Community Based Services as opposed to Nursing Home Medicaid. The next step in the application process would be document preparation. Medicaid requires that certain documents be submitted along with the application. Some of the most important documents include identification, proof of residency, recent financial statements (bank accounts, investments, 401Ks, etc.), Social Security Administration Letter, and Tax Forms, among others. It’s important to note that some of these documents must go back at least 5 years prior to the date of the application. Collecting the proper supporting documents can be an overwhelming process, which is why a Medicaid planning attorney is invaluable when it comes to applying to Medicaid.

It is indeed possible for those enrolled in Medicare to apply for Medicaid. For the most part, dual eligibility is not an issue. However, there are a few points to keep in mind as having Medicare coverage can affect Medicaid benefits. Medicaid is a program that is designed to be used as a final expedient for individuals within a low income bracket who cannot cover the cost of certain healthcare expenses, such as long-term care. As such, Medicare and other healthcare programs are required to pay claims before Medicaid can be used. That is to say, an individual with dual eligibility will utilize Medicare for coverage first. Medicaid will be utilized last for any healthcare services not covered under Medicare.

One of the most common mistakes people make when creating a special needs trust is procrastination. This is especially true for parents of children who are born with disabilities. Setting up a trust early in the child’s life allows for contributions and gifts to accumulate and grow throughout the years without penalties. Another mistake is trying to set up a special needs trust without legal assistance. There are a lot of “DIY” tutorials available, but unless a person specializes in New York law, government programs, and public benefits, there is a wide margin of error that can occur and result in a disabled person being left out of critical benefits. Failing to make a special needs trust irrevocable is one more mistake that is quite common. This is particularly true for self-settled special needs trusts. A trust that is revocable can be considered an asset under certain government programs. As such, they can be counted against an individual’s asset threshold, making them ineligible for certain programs and benefits.

A special needs trust is designed, in part, to keep others from taking advantage of someone with a disability. However, even within the sound legal structure of a trust, misuse of funds can still occur. In order to prevent this from happening, the trustor needs to ensure that specific instructions are included in the trust document with regards to how the funds are to be managed and administered. Another important preventative measure is to designate a trustee that is reliable and who will oversee the trust with integrity and honesty.

At Morgan Legal Group, P.C., we handle estate planning as well as the creation of special needs plans and trusts. We understand that for many families, estate planning and special needs planning go hand in hand. This is why, in addition to their extensive knowledge of the best estate planning practices, our attorneys specialize in the laws, programs, and benefits for individuals with disabilities.