Medicaid FAQs

What is the difference between Medicaid and Medicare?

Medicare is a program underwritten by the federal government which provides a variety of health benefits to senior citizens, individuals with chronic illnesses and individuals who are disabled. Medicaid is a program based on financial needs of individuals with very low income levels and/or minimal assets. Both of these programs provide healthcare benefits.

What do I do to receive Medicaid benefits?

There are a variety of rules and eligibility requirements to receive medicaid benefits. Individuals applying for Medicaid benefits must provide a financial history with regard to their financial transactions, income and assets. There are basically two types of Medicaid benefits. The first one is community benefits and the second one is nursing home benefits. Community Medicaid benefits involving having home health care aids assist you in your home. Nursing home benefits involve Medicaid paying for nursing home expenses. There are many rules, regulations and application issues that must be dealt with to qualify for either type of Medicaid benefits. We suggest you contact one of the attorneys at our office to discuss Medicaid issues.

How long does the underwriting process to obtain Medicaid benefits take?

Medicaid benefits are processed by each county within the metropolitan New York area. The length of time the processing of your application can take depends on whether you are looking for community Medicaid or nursing home Medicaid. It also depends on the amount of income you have had and your assets during the previous five years. A reasonable estimate of the time it takes for Medicaid to approve an application is approximately three to six months.

Please explain how Medicaid works with other types of medical insurance?

Medicaid is considered to be the payer of medical bills of last resort. Whether you have private medical insurance or Medicare, all of these benefits would have to be utilized before Medicaid would consider reimbursing you for your expenses.

What are spouse allowances under Medicaid?

The spouse allowance under Medicaid for the community spouse (spouse living at the marital residence) deals with the amount of assets the community spouse can retain and the amount of monthly income to be received by the community spouse. Starting January 1, 2013, the Community Spouse Resource Allowance (CSRA) goes from $74,820 and reaches a maximum at $115,920 (this excludes the value of the marital residence).

As of January 1, 2013, the community spouse’s monthly income allowance is $2,898. In the event the community spouse’s income is less than $2,998, he or she can receive contribution from the monthly income of the Medicaid applicant spouse.

What is spousal refusal within the context of receiving Medicaid benefits?

This is where the community spouse refuses to make payments on behalf of the Medicaid applicant spouse. Although the assets of the community spouse in excess of the spouse allowance will be deemed available to the Medicaid spouse, the community spouse can refuse to make these payments. The community spouse must file a spousal refusal to prevent Medicaid from denying benefits from the applicant spouse. Once the community spouse files a spousal refusal, the income and/or assets of the community spouse will not be considered available to the Medicaid applicant spouse. In many situations when a spousal refusal is submitted by the community spouse, they are sued by the Department of Social Services to set aside this refusal.