Medicaid: What You May Need To Know

New York Connects provides helpful information to frequently asked questions about Medicaid to help you plan for the future.

What is Medicaid?

Medicaid is a program for New Yorkers who can’t afford to pay for medical care. Often times people needing home care and skilled nursing homes will need to apply.

What information is needed to apply for long term care or a nursing home through the Medicaid program?

The current laws require that a person applying for these services under Medicaid submit 60 months worth of the following documentation from the date of application:

1. Copy of Power of Attorney

2. Birth Certificate, baptismal certificate or driver’s license

3. Marriage certificate – if spouse deceased – copy of death certificate; if separated or divorced – proof of separation or divorce

4. Verification of present address with shelter expenses or proof of residence prior to admission to nursing home

5. Last four pay stubs if employed

6. Award letter or photocopy of most recent check for:

Social Security/Railroad Retirement

Pension or retirement

Veteran benefits

Union benefits/workmen’s compensation benefits

New York state disability insurance

Court-ordered support/alimony payments

7. Rental Income – verification of amount received, tax bills, maintenance and repairs and utilities paid

8. All bank and credit union checking and savings account transactions – for open and closed accounts

9. Explanation and proof (including receipts and canceled checks) of all withdrawals and deposits over $1,000 for bank accounts, investments, retirement plans, annuities

10. Life insurance policies, verification of current cash values and name of beneficiary

11. Vehicle registration and title for all vehicles in household. If sold or transferred within last 60 months, provide documentation

12. Stocks, savings bonds, securities – even if currently closed or surrendered- and any transactions with in the last 60 months

13. IRAs/Employee-related pension funds/Keogh plans/401 K statements – for the last 60 months

14. Burial fund agreement/current bank statement

15. Deed to all property owned – if life use or real estate in property – must see the transfer deed

16. Current proof of mortgage/escrow, tax bills, and homeowners insurance on all properties owned

17. Income tax returns for the last five years – including all 1099s

18. Original annuity contracts and verification of any income received. Annuities are subject to a 60-month review.

19. Trust documents and amount of principal and interest. Can principal be invaded? Limitations, if any? Trusts are subject to a 60-month review period

20. If applicant (or spouse) sold or transferred property within the last 60 months provide proof of value at time of sale/transfer, closing statement of sale/transfer

21. Proof of health insurance, proof of last premium paid and letter of credible coverage for prescription plans

22. Letter verifying Medicare cut-off dates, health insurance payments and cut off dates and private payments made to the nursing home if applicable

23. Bills showing any current outstanding medical bills including nursing charges

24. Armed services home discharge papers or proof of military service for applicant/spouse

What is a “lookback” period?

When applying for Medicaid for nursing facility services (nursing homes), the local Department of Social Services will look at financial transactions to determine whether any assets have been transferred or given away for less than fair market value during a certain time period prior to your application in order to determine if a transfer of assets penalty period needs to be applied. This is known as the “lookback” period. Currently the “lookback” period is 60 months, or five years, prior to the month you are applying for coverage of nursing home care.

A penalty period may be imposed for the transfer of non-exempt assets for less than fair market value. The penalty period results in a period of intelligibility for Medicaid coverage of nursing facility services. A penalty period is not applied for the transfer of your home to the following individuals:

Spouse

Child under the age of 21

Sibling who has an equity interest in the home and has resided in the home for at least one year immediately prior to you entering the Nursing Home.

Adult child who resided in the home for at least two years, immediately prior to you entering the nursing home and who provided care to you which permitted you to reside at home rather than in a medical facility.

For more information regarding the transfer of assets and penalty periods, please contact your local department of social services.