What Does Community Medicaid Cover in Long Island, New York?

For long-term care, there truly is no place like home. Maintaining independence and receiving vital medical services ensure the highest quality of life possible in later years. Community Medicaid in New York allows individuals to access a range of essential services such as doctor and clinic services, hospital stays, prescription medications, and more to enable them to age with dignity and comfort.

Residents on the East End of Long Island may wonder, “What does Community Medicaid cover and how can I qualify?” if their income or resources exceed the limits.

This blog from a knowledgeable and experienced Medicaid attorney provides a comprehensive overview of Medicaid. It explores eligibility requirements, income and resource limitations, and strategies to qualify.

However, consulting a Community Medicaid Planning attorney on the East End of Long Island is crucial to establish a sound, airtight plan that allows you to remain in the comfort of your own home for the long term. By engaging in proper advanced planning with a professional, you can rest assured knowing that your elder law attorney will thoroughly explore all options to enable you to remain at home, instead of going into assisted living or a skilled nursing facility.

As a Medicaid applicant working with an elder law attorney, you can pave the way for Community Medicaid benefits for an invaluable layer of financial security. Continue reading to learn more, then contact us at (631) 506-8440 to schedule a consultation with a Medicaid attorney at Sheryll Law, P.C.

What is Community Medicaid in NYS?

Community Medicaid is a type of health insurance that permits individuals to remain in their communities while receiving necessary care. This program is specifically designed for seniors who choose to age in place but require some level of assistance.

Unlike Institutional or Nursing Home Medicaid, which supports individuals entering long-term care or skilled nursing facilities, Community Medicaid offers elderly New York residents the best of both worlds: the opportunity to live in their own homes and receive the necessary additional care.

Community Medicaid recipients typically need help with basic daily activities including eating, dressing, toileting, bathing, and transferring. Eligible individuals living in assisted living facilities can also benefit from Community Medicaid.

What Does Community Medicaid in New York Cover?

The NYS Department of Health’s Community Medicaid program offers the following.

  • Medical services such as doctor visits, lab tests, and X-rays.
  • Comprehensive drug coverage for prescription and non-prescription medications.
  • Home care, personal care aides, adult daycare, and transportation to medical appointments.
  • Physical, occupational, and speech therapy.
  • Mental health services.
  • Durable medical equipment, orthotic and prosthetic appliances.
  • Light housekeeping.

Whether you choose to continue residing in your home or an assisted living facility, you may be eligible for these services through Community Medicaid.

Medicaid Eligibility Requirements & Financial Limits

Medicaid is a program for individuals with low income and limited resources. To determine Medicaid eligibility as of 2023, Medicaid laws evaluate two financial categories: income and resources.

Income includes regular incoming funds such as Social Security, pensions, or distributions from an IRA. Resources refer to any assets a person possesses, such as savings, stocks, bonds, real estate, retirement accounts, or an undistributed IRA.

2023 Community Medicaid Income Limits:

  • $30,182 in non-exempt assets for a single applicant
  • Up to $1,677 a month in income for a single applicant
  • Up to $2,268 a month for couples
  • $40,821 in non-exempt assets for a couple applying
  • Up to $2,268 a month in income for a single applicant

2023 Limits for Resources to Qualify for Community Medicaid:

  • $30,180 for individuals
  • $40,820 for couples

Applicants who do not require long-term care coverage can declare their assets without providing documentation. If seeking long-term care coverage, applicants must document their resources.

Previously, the difference between qualifying for standard Community Medicaid and Community Medicaid with Long-Term Care relied solely on resource documentation. However, New York State intends to implement a “Look-Back Period of 30 Months” for applicants seeking Community Medicaid with Long-Term Care. During this period, individuals who made gift transfers may face penalties and be denied access to Medicaid Long-Term Care services for a specific duration. The official start date for this look-back period is currently scheduled for no earlier than March 31, 2024.

Can Individuals with Incomes and Resources Above the Medicaid Limit Still Qualify?

If an individual’s income and/or resources exceed the Medicaid limit, they have several options to qualify for Medicaid.

Health Insurance Premiums

Money paid toward a health insurance premium is exempt and will not be counted when determining Medicaid income.

Pay-In and Spend-Down

An individual could pay the amount that exceeds the income limit to Medicaid to receive benefits, or “spend down” excess income by paying medical bills. Once the person has paid off the amount that exceeds the limit, Medicaid will cover any additional costs. For those only slightly above the income limit, paying in or spending down can be viable options.

Earned Income

If someone falls into the aged, disabled, or blind category, earned income is budgeted favorably. First, a $65 disregard is applied to the total earned income. Then, the remaining income is divided by two to determine the budgeted earned income. For instance, if an individual earns $1,065 per month, Medicaid will deduct $65, leaving $1,000. This amount is halved, leaving a budgeted earned income of only $500.

Pooled Income Trust

A popular method for individuals exceeding the income limit is to place their excess income into a pooled income trust. In New York State, excess income in a pooled income trust is disregarded for Community Medicaid budgeting. Proving disability for someone who needs long-term care is not usually difficult. However, money placed in a pooled income trust cannot be withdrawn as cash but can be used to pay bills on behalf of the beneficiary.

Holocaust Restitution Payments

When applying for Medicaid, restitution payments received from the Holocaust are not considered part of an applicant’s income and are not counted when determining eligibility.

Spousal Impoverishment Budgeting for Medicaid Recipients in Managed Long-Term Care (MLTC)

If a Medicaid recipient is enrolled in a Managed Long-Term Care (MLTC) plan, their spouse is entitled to receive a portion of their income. The combined total income of the couple, including the spouse’s share, cannot exceed $3,715.50 per month. This requirement is the Minimum Monthly Maintenance Needs Allowance (MMMNA). Additionally, the Medicaid recipient enrolled in MLTC can receive a Personal Needs Allowance (PNA) of $591 per month. Together, the couple can have a maximum monthly income of $4,306.50 and still meet the Medicaid limit, as long as one of them is enrolled in MLTC.

Most Favorable Budgeting for Medicaid Recipients in Managed Long-Term Care (MLTC)

Medicaid recipients enrolled in MLTC plans can be assessed on the “most favorable budgeting” for their income. They can choose to be evaluated as a single applicant or utilize the Minimum Monthly Maintenance Needs Allowance. It’s beneficial for couples when one spouse’s income exceeds the eligibility limit, and the other’s income alone would qualify them for Medicaid.


Although real estate is normally considered an eligible asset in an applicant’s resources, Medicaid laws provide an exception for an applicant’s primary residence if the equity value is within $1,033,000. Despite this exemption, Medicaid has the right to recover from the recipient’s equity in their residence after their death. To safeguard their residence from Medicaid estate recovery, many individuals seek the assistance of a Medicaid planning attorney. Applicants whose spouse or child under the age of twenty-one, blind, or disabled live in the home are not subject to the $1,033,000 limitation.

Let the Medicaid Planning Attorneys at Sheryll Law Help You Become Financially Eligible for Community Medicaid

Achieving Community Medicaid eligibility is a complex process that requires the assistance of an experienced elder law attorney. At Sheryll Law, P.C., our experienced Medicaid planning lawyers and dedicated staff provide each client with individualized attention and legal services and documents that specifically suit their family’s lifestyle, protect assets, and pay for future healthcare costs or special needs that may arise.

From Medicaid benefits to advance directives and all elder law matters, let us protect you and your loved ones. Our practice concentrates on New York elder law; you can trust our knowledge and experience to guide you and your family in navigating the complexities of Medicaid planning and creating a comprehensive estate plan that accounts for contingencies. Call us at (631) 506-8440 or complete our online form to schedule a consultation.

Copyright © 2023. Sheryll Law, P.C. All rights reserved.

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.

Sheryll Law, P.C.
633 East Main Street, Suite 2
Riverhead, New York 11901
(631) 506-8440

Leave a Comment