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Senior Citizen's Guide to Cleveland

Top 5 Medicaid Myths



By: Judith Grimaldi, CELA, CAP, and Pauline Yeung-Ha, Esq.

Myth #1: An Alzheimer’s patient cannot quality for home care benefits under Medicaid.
The key to applying for Medicaid benefits for home care is to demonstrate the need for assistance with ADLs (activities of daily living). Medical professionals must provide a detailed explanation of which ADLs require assistance, such as “patient forgets to eat,” “is suffering from malnutrition,” etc. When the Alzheimer’s patient has unmet personal care needs, this meets the medical necessity criteria for Medicaid home care eligibility. The patient’s doctor would be very important in identifying these needs.


Myth #2: I will lose my house if I apply for Medicaid.
The home is considered an exempt asset, up to a certain equity value, and is not counted as a resource in the Medicaid application process. As a precaution, the house should be transferred out of the patient’s name to avoid future recovery of Medicaid benefits upon the recipient’s death. It is also exempt if a spouse, dependant or disabled child resides there.

Myth #3: Even if I qualify for home care benefits, I will lose my current home care worker and must use Medicaid’s home care attendant.
A Medicaid recipient can apply to retain the current home care worker through a program called “The Consumer Directed Personal Assistance Program” (CDPAP) which allows the disabled person to select their own qualified workers and set their work schedule. The CDPAP program serves as a fiscal liaison between Medicaid and the patient’s family to pay the salary of the authorized home care worker. The patient’s family supervises the home care worker, while CDPAP manages the home attendant’s payroll.

Myth #4: I can’t apply for benefits because I have transferred assets and I must wait for a 60-month period to expire.
The 60-month look back rule is not a penalty period, but rather a “financial review” period, and is for nursing home Medicaid applications. For home care benefits in New York, the “look-back” period is only one month.

Myth #5: I can’t qualify for Medicaid because I have too much money in my bank account.
Medicaid currently has a resource limit of $14,250 for an individual ($20,850 for a couple). If the Medicaid applicant’s assets are below this threshold, then he/she will be eligible for benefits. However, if the assets are above the resource limit, this would require the Medicaid applicant to institute an asset protection plan which he/she would either transfer the funds to an exempt person, or gift the funds to a Trust which may result in a waiting period for benefits. Early planning is crucial, especially for Alzheimer’s patients, when their mental capacity begins to diminish.

Judith Grimaldi, CELA, CAP, and Pauline Yeung-Ha, Esq., are members of the National Academy of Elder Law Attorneys (NAELA).
This information is provided as a public service and is not intended as legal advice. Such advice should be obtained from a qualified Elder Law attorney. To find one in your area, visit www.NAELA.org and click on “Find An Attorney.”

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