Medicaid & the Partnership

The goal of the Partnership program is financial independence for consumers through shared responsibility. This means New York State will share with participating consumers in planning for their long-term care expenses. If an individual/couple purchases a Partnership insurance policy and keeps it in effect, the State will protect them, if otherwise eligible, against the costs of extended care situations through the Medicaid program.

Medicaid that is available to a qualified Partnership policyholder (QPP) who has met the minimum duration requirement under his/her policy is called Medicaid Extended Coverage (MEC). The Total Asset Protection Plans allow for the disregard of all of the QPP's resources (assets) in determining eligibility for MEC. The Dollar-for-Dollar Asset Protection Plans allow for the disregard of the QPP's resources (assets) under MEC up to the total amount of benefits paid out by the participating insurer on behalf of the QPP. For both plans, income and the cost of care are considered in determining Medicaid eligibility.

The table below shows 2018 Medicaid resource and income allowances. The resource allowances do not apply to the Total Asset Protection Plan QPP. In the case of the Dollar-for-Dollar Asset Protection Plan QPP, the resource allowances in the table would be in addition to the dollar amount paid by the Partnership policy on behalf of the QPP.

RESOURCE ALLOWANCE

INCOME ALLOWANCE(monthly)

Nursing home    
Applicant $15,150 $50
Community spouse $123,600 (maximum) $3,090
Home care (community-based long-term care services)    
Applicant $15,150

$842

Increased to $1,545 for QPP's

Applicant with spouse $22,200

$1,233

Increased to $3,090 for QPP's

 

Where the community spouse of a Medicaid eligible nursing home resident has monthly income which exceeds the allowance, he or she is requested to contribute 25% of any income over the allowance to the costs of care of the Medicaid eligible nursing home spouse. This circumstance also applies to a couple at home where the Medicaid recipient is receiving specific home and community-based waiver services under the New York State Medicaid Long-Term Home Health Care Program, or receiving services under a Program of All-inclusive Care for the Elderly (PACE) program. For a description of Medicaid eligibility and the treatment of income and assets under the Partnership program, click here: http://www.nyspltc.org/docs/medelg.pdf

A Mention about Assisted Living:  It is important for Policyholders to ask the Assisted Living Residence (ALR) what kind of payment it accepts. Many ALRs accept private payment or long term care insurance, and some accept Supplemental Security Income (SSI) as the primary method of payment. Currently, Medicaid and Medicare will NOT pay for residing in an ALR, although they may pay for certain medical services received while in the ALR, such as in the case of the New York State Assisted Living Program (ALP).  For more information, please click the following links:

https://www.health.ny.gov/publications/1505.pdf

https://www.health.ny.gov/health_care/medicaid/program/longterm/alps.htm

For a complete description of Medicaid Extended Coverage for New York State Partnership for Long-Term Care policyholders, including liens, recoveries and treatment of transfers, click here: http://www.health.ny.gov/health_care/medicaid/publications/docs/adm/09adm-3.pdf

Useful Links