Approximately one in four New York State residents are covered under Medicaid, a government program that provides low-income people with basic health insurance.
Medicaid is administered by each state, and by law, certain benefits, such as hospital, primary physician, nursing facility and home health services, must be included in every plan. Optional benefits, including eyeglasses and vision care, rehabilitation, case management and nursing home diversion programs, may be offered through state-specific waivers.
To qualify for long-term Medicaid coverage in Saratoga County, seniors aged 65 and older may earn up to $859 per month and own up to $15,450 in countable assets. Married couples applying together may earn up to $1,267 per month and own up to $22,800 in joint countable assets.
Medicaid Community Spouse Resource Allowance
If only one spouse in a married couple requires Medicaid, any income earned by the community spouse is disregarded and the single income limits apply. The community spouse can also keep up to half of the couple’s joint assets, worth up to a maximum value of $126,420.
Some assets are classified as Medicaid-exempt, meaning the value of these assets aren’t included in the asset limit. An owner-occupied residence worth up to $858,000, one vehicle, an irrevocable burial trust and personal effects are all exempt.
Medicaid Excess Income Program
Seniors aged 65 and older and adults who are blind or otherwise disabled with income that exceeds Medicaid enrollment limits may qualify for coverage through the Medicaid Excess Income program.
Also called Medicaid spend-down, MEI works like a deductible on an insurance policy. Each month participants must spend a predetermined portion of their excess income on medical expenses. Once that limit is reached, participants are provided with Medicaid coverage for the remainder of the month.
For more information on New York Medicaid and the MEI program, contact the NY Medicaid Helpline at (800) 541-2831.
Assisted Living Program
Low-income seniors who meet the Medicaid criteria for nursing home placement but don’t require around-the-clock medical care may qualify for the Assisted Living Program. This nursing home diversion program provides a wide range of services that enable seniors to reside in a participating assisted living facility, such as:
- Adult day health care
- Physical, occupational, and/or speech therapy
- Homemaker services
- Personal care services
- Skilled nursing
- Access to an emergency response system
- Medical supplies
- Mobility devices
- Case management by a registered nurse
To enroll in the ALP, seniors either need to be Medicaid recipients or be able to cover the program costs on a private-pay basis. Statewide, ALP enrollment is capped at 4,200 participants and about 85% are covered by Medicaid.
For more information on the ALP, contact the Saratoga County Department of Social Services at (518) 884-4140.