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Elder Law Attorneys get a Big Win for Medicaid

Married Couples can continue to access Medicaid home care and protect their monthly income.  Medicaid limits how much income a Medicaid applicant-spouse can have while receiving home care benefits.  Recent changes in the rules restricted spouses from protecting their income through the use of a Pooled Income Trust.

The Rules:

On November 3, 2014, New York State Department of Health issued a new directive on Spousal Impoverishment Medicaid Budgeting (GIS 14 MA/25).  This new ruling rescinded GIS 14 MA/015 which mandated that a Medicaid Home Care recipient may only budget his/her income by giving his/her spouse a ‘community spouse monthly income allowance’, in the amount of $2,931 for 2014 (less other minor allowances) and eliminated an ability for the Medicaid Home Care recipient to use a Pooled Income Trust for income budgeting.

In response to the advocacy of your local Elder Law attorneys, the new directives states that spousal impoverishment budgeting with post-eligibility rules is NOT mandated for married individuals receiving Medicaid Home Care and Community Based Services.  Instead, the new GIS resumes the application of GIS 12 MA/0113 and GIS 13 MA/018, allowing for spousal impoverishment budgeting with post-eligibility rules only when it is more advantageous to the applicant.

What it Means:

Simply put, married Community Medicaid recipients will now have the option of how they wish to budget their income, in a way that is most advantageous for them.  The Medicaid recipient can once again choose to utilize a Pooled Income Trust for their expenses.

This can be particularly helpful to a community spouse who, on their own, has sufficient monthly income and therefore, there would be no contribution from the applicant spouse.  Without the new ruling, the applicant would have to pay any monthly income overage directly to the MLTC (Managed Long Term Care provider).  With the new rule, the applicant can save his/her excess income to pay for expenses by submitting it to a pooled income trust.

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