May is Older Americans Awareness Month:

The Revolution in Longevity Has Created Opportunities and Risks

You may be older than you used to be, but you’re still the person you always were.  That’s a message younger people need to learn.  A 70-, 75- or 80-year-old person, whether robust and fit, or even if compromised in some way, is often still active and fully involved in living – an individual, not a geriatric leftover. 

Getting older doesn’t have to be all aches and pains.  In fact, studies have shown that older people are happier than those in the middle period of their lives, even if they have health or other issues.

Years ago, people didn’t realize that they could lengthen their active years, sometimes by decades, by taking steps to maintain their mental and physical health.  In recent years, science has shown that diet, exercise, community connection, good sleep habits, and a sense of purpose can improve people’s health and mental faculties, and often dramatically lengthen their lives.

Medicines and medical equipment have also extended lives.  Heart disease is being fought on many fronts, as is cancer in all its forms.  Joint replacements and diabetes management have involved high tech medical equipment that has been miraculous for millions.

Physical changes do come with the passing of time, but again, people have learned to take preventive measures to limit or postpone the risks and negative effects.  Learning about fall prevention, balance and strength exercises, protecting skin against sun damage, and wearing sunglasses to prevent cataracts are all actions people have learned to take, to help them avoid problems and continue to enjoy their lives.

One of the challenges people face when they live far longer than they used to, is that they may need care and assistance in their homes or in a residential facility for a decade or more.  They can still live satisfying lives, but they need assistance with some of their activities.  With families far more spread out than was the case decades ago, this care is often provided by paid caregivers.

People who begin needing care often don’t realize until well into their assistance-needing period, that caregiving can be a disastrous drain on their finances.  Caregivers aren’t getting rich, but they need to be paid, and home health companies have both legwork and paperwork for which they need to be compensated.  

The combination of these factors means that costs can skyrocket, and the net result of paying for care is often that people’s entire life savings are wiped out.  People try to reduce the cost of care by paying their caregivers in cash.  Not only is this illegal, it exposes the employer to enormous liability, should the caregiver be injured on the job.

The attorneys at Lamson & Cutner feel it is crucial for older people, and the children or loved ones of those older people, to be informed.  Learning about the financial risks of long-term care costs, and about the opportunities that are available to protect them against these risks, will enable those who need long-term care to maintain their lifestyles to the greatest extent possible.

Our firm spends a lot of time and energy on educating people about issues surrounding long-term care.  We have worked to make our website informative, understandable and useful.  In addition, we have a very busy speaking schedule.  We are authorized to give CEU credits to health care professionals and social workers.  We also give general-interest presentations at senior centers, houses of worship, and other venues, to people who might face long-term care costs for themselves or others.

Becoming informed – and taking action – are your best defenses against both the physical and financial risks that come with age.  You’re never too old to start.  Learn, act, and live your best life!

New York’s Consumer Directed Personal Aid Program (“CDPAP”):

Huge Changes are Arriving NOW

New York's CDPAP program allows a person who is eligible for NY Medicaid home care, or their designated representative, to select, hire, train and schedule their own caregivers.  The caregiver can be a friend or family member other than a spouse.  An MLTC (Managed Long Term Care) plan determines how many hours of care will be granted.  The disabled person or their representative is the employer, and they are responsible for arranging their own back-up coverage.

Until the end of this month, about 600 Fiscal Intermediaries (“FIs”) handle payroll, time sheets and benefits under a contract with an MLTC plan or local Medicaid agency.

CDPAP allows more flexibility than traditional personal care:

Right now:

A Huge Change is Coming on March 28

New York selected one company located in Georgia, called PPL, to replace the over 600 current CDPAP Fiscal Intermediaries.  All MLTC plans, other managed care plans, and Medicaid agencies must sign a contract with PPL.  37 of the current NY Fiscal Intermediaries have been selected as “facilitators” with a limited role: customer service, transition assistance, and visitation verification support.

What does this mean?

Many changes will or may occur – wages may drop, overtime could be affected, documentation of care will change, and some CDPAP PAs may not successfully transition to become employees of PPL.  Any of these changes may negatively affect the care that people receive.  As the sole payer and administrator of CDPAP employees, PPL could be pressured to keep wages low or introduce other restrictions.

A CDPAP PA may switch to traditional personal care (if permitted by the family rules), but will need to be trained, will not be able to administer meds or perform many other “skilled tasks,” and will become an employee of the Licensed Home Care Service Agency – so they could be assigned to another consumer.  The consumer is no longer in control.

The rollout is already proving to be chaotic and messy.  There have been reports of unreturned phone calls to PPL and poor customer service.  The change will cause disruption to many thousands of people who receive care, and to their caregivers.

What Should You Do?

If you are using CDPAP services and have not yet begun the transition process: START NOW.  As of March 3, there were still 150,000 consumers and 400,000 workers who had not begun the transition process – and it takes weeks to complete!  Workers will not be paid for work done after April 1 if the consumer and the worker did not complete the registration – and (for the moment) there is NO backup plan for people still in the pipeline.  Don’t lose your services – act now.

The patient or family needs to initiate the transition to PPL:

Facilitators have been very helpful with helping people to set up accounts – do not hesitate to call them for assistance!

Helpful links:

Overview with link to register:  https://pplfirst.com/programs/new-york/ny-consumer-directed-personal-assistance-program-cdpap/

List of NY facilitators:  https://pplfirst.com/cdpap-facilitators/

To request an appointment for in-person support, email NYCDPAP@pplfirst.com

In-person and virtual registration sessions:  https://pplfirst.com/cdpap-resources-events/

NY State has published 2025 Medicaid threshold levels and nursing home Regional Rates: Some will change when new Federal Poverty Levels are announced

The New York Medicaid limits and thresholds for 2025 have been published - but they will probably change in February. The NY Medicaid eligibility limits for income and "resources" (assets) are tied to the Federal Poverty Level ("FPL"). That figure is normally published by the Federal Government in February, so when that happens, NY Medicaid levels will be adjusted to account for changes in the FPL. Nursing Home "Regional Rates," used to calculate the nursing home Penalty Period, have now also been published. Regional Rates will probably not change.

Below is our currently-valid 2025 Medicaid Quick Reference Chart. It shows useful information regarding the limits imposed on income and resources for people who are applying for (or renewing) Medicaid coverage. The chart can also be found on our website here.

A Shocking Surprise Regarding Urgent Care Facilities

A recent article in the New York Times, written by a doctor, revealed that different urgent care facilities sometimes charge wildly different prices, based on their status.  The doctor’s daughter needed an x-ray, and the urgent care billed them for hospital-based x-rays.  The doctor, who works in a hospital, was expecting a bill of around $200, but instead she received a bill for $1,168.

[Here is a link to the article.  It is a “gifted” article so there should be no paywall.]

The doctor discovered that some urgent care facilities are hospital-affiliated, and are deemed to be “hospital outpatient departments,” or HOPDs.  The article states, “there is no federal protection for patients who are unknowingly treated in higher-priced hospital affiliates that look like normal doctors’ offices or urgent care clinics.”  In other words, nobody at the urgent care is required to tell you that they may charge you far more than the non-hospital-affiliated urgent care facility down the street.

A study by the National Institute for Health Care Reform (NIHCR) found that “Average hospital outpatient department prices for common imaging, colonoscopy and laboratory services can be double the price or more for identical services provided in a physician’s office or other community-based setting.”  The study found that prices vary across and within local markets. 

Hospitals, and the American Hospital Association, have attempted to justify these costs by claiming that HOPDs treat patients who are sicker.  But often, regardless of the patient's health situation, the procedure is identical.  A broken ankle x-ray is the same no matter who gets it or where it is performed.  In addition, when someone needs urgent care, one clinic looks the same as the next.  Charging a different price appears to have far more to do with a profit motive than the health status of the patient.

In recent years, hospitals have been acquiring physicans’ practices.  In the case of urgent care clinics, this allows them to change the designation of what was formerly a community-based facility into an HOPD.  Insurers often cover the same amount for a procedure regardless of where it is performed.  The result is that a large bill for the amount over the covered cost often ends up falling on the patient who unwittingly used an HOPD.  If the bills from your local urgent care provider have skyrocketed recently, you may be a victim of this status change.

Even more surprising to me, is that the NIHCR study about higher costs in HOPDs was published in 2014.  I had never heard of this secret dichotomy before I read the NYT article.  I called the walk-in clinic associated with the medical practice I usually use, and was told that yes, they are an HOPD.  That would probably explain the egregious $300+ cost of a recent 10-minute visit to examine a large rash that surrounded a bug bite I received (Lyme test, extra cost, negative).

I checked several of the urgent care facilities in my area and their websites said nothing about their HOPD status.  If you are using an urgent care facility, or might need to, it would make sense to call several, and if you can get through to a human being (not often an easy task), ask them.  Finding an urgent care that is NOT billing as a Hospital Outpatient Department could save you thousands of dollars over time, or even in one visit.

New Hurdles Imposed for Medicaid Applicants in New York State

New York state recently enacted legislation, and declined to moderate existing legislation, that makes accessing the state’s Medicaid program more difficult and complicated. 

I. The Consumer Directed Personal Assistance Program (“CDPAP”) will undergo major changes. 

Currently over 600 companies act as Fiscal Intermediaries (FIs) for the CDPAP program.  These FIs assist people who hire Personal Assistants (“PAs”) through the CDPAP program, by handling payroll and benefits.  FIs sometimes also help consumers find and train Personal Assistants.  These intermediaries are often small, local companies.  FIs are under contract with, and are paid by, Medicaid Long Term Care (“MLTC”) plans, mainstream managed care plans, and local Departments of Social Services that authorize CDPAP services.

Now the NYS Department of Health will be required to contract with a single Fiscal Intermediary – and that intermediary must already be operating in another state as a statewide FI.  That single FI will subcontract with a small number of existing FI programs.  By April 1, 2025, all 200,000 CDPAP consumers and their PAs will be transitioned to the new SINGLE FI or one of their few subcontractors, and ALL other FIs must stop operating.

That means that whichever FI is chosen, and its few subcontractors, are likely not to have a local presence in many of the parts of the state, and consumers who hire Personal Assistants will be dealing with a huge corporation rather than a small, responsive service provider.  This will eliminate almost all choice, as well as competition, from the current 600 providers.

II. CDPAP Personal Assistants may have new training requirements

The new law authorizes the Department of Health to adopt regulations “to carry out the objectives of the program including … training requirements for PAs.”  Currently, the consumer or their representative trains the PAs, and no outside training is required.  CDPAP PAs are then able to perform numerous critical tasks that long-term care aides are not permitted to perform.  These tasks include assisting patients with taking medications, injecting insulin, administering oxygen, and other duties that would otherwise require the costly services of a nurse. 

If additional training is required, this obligation will discourage potential candidates from becoming PAs.  These important workers are already in short supply: fewer PAs will mean it will take longer – or it might be impossible – to find an assistant.

III. Cuts to Medicaid that are still scheduled to occur:

The 30-month “look back” and transfer penalty for Community Medicaid services, which was enacted but which was delayed due to COVID, was not repealed.  This measure is scheduled to be implemented in 2025.  Implementation will delay or effectively deny home care services that are crucial to enable people to remain in their homes as long as possible.

This complicated change will be a nightmare to implement.  The look back will impose a penalty period for transfers made in the 30 months prior to a person applying for Community Medicaid services (these services include paying for some Assisted Living residences).  There is currently no look back.

Currently, disabled people who require assistance with two Activities of Daily Living (“ADLs”) qualify for Community Medicaid services (if financial eligibility is achieved).  Implementation of this measure will require that people need assistance with three ADLs before they are eligible. 

This increased requirement will make it far more difficult for seniors in declining health to access Medicaid services.  In addition, the New York Legal Assistance Group states that this “will deny Medicaid home care illegally to Those With Vision Impairments, Intellectual & Developmental disabilities, Traumatic Brain Injuries, and many other disabilities.”  This requirement will go into effect in Fall 2024 if not repealed.

The New York State Bar Association, New York Legal Assistance Group, and the National Association of Elder Law Attorneys are all fighting to repeal this harmful legislation.  Our firm will support their efforts.

Ongoing changes to New York State’s long-term care regulations mean that it is more important than ever for anyone over 65, or earlier if you have health issues, to consult with an experienced Elder Law attorney.  The sooner you take action, the more long-term care planning can help you.  During a consultation with our firm, our attorney will explore your situation, thoroughly explain your options, and enable you to decide for yourself what plan makes the most sense for you.  

The most effective planning occurs before you have a need for long-term care, but planning can still have enormous benefits even if undertaken later.  Don’t hesitate to call – a consultation will provide you with important information and can give you priceless peace of mind.

More information on all of the CDPAP changes is available at this link: Drastic CDPAP Changes and other Medicaid Outcomes of Final NYS 24-25 Budget - New York Health Access (wnylc.com)

6 Critical Issues upon Discharge from a Hospital or Rehab

If you or your loved one is being discharged from a hospital or rehab facility, either to a home or to assisted living, focusing on the following six issues can be critical:

  1. What temporary or ongoing assistance will be needed (home aide, meals, housekeeping)
  2. How to remain healthy (proper medication management)
  3. How to remain safe (a home safety plan)
  4. Where will you find the aides you need, and who will manage them
  5. How to manage care – family / friends or a professional Care Manager
  6. A key, but often neglected, aspect of care is: How will you pay for it? Medicare will not pay for long-term care, and unless you are very wealthy, the cost of care can wipe out your entire life’s savings.

(Note:  Discharge to a nursing home is not discussed in this article) 

This checklist will give you a good starting point to keep yourself or your loved one happy, safe, and healthy as long as possible.  We also want to emphasize that you CAN protect yourself from financial disaster when health care costs start to climb.

When You Are Discharged, What Issues are Most Pressing?

Issue #1:  Help in the home, assisted living, or help in an assisted living

People coming from a hospital or rehab may need ongoing short or long-term care.  The institution’s designated liaison (usually a social worker) will recommend the appropriate level of care, based on the patient’s needs.  The social worker will also give a list of providers, such as assisted living residences or medical resources, that may be necessary for the patient’s care.    

 If the patient can go home, but needs more care, they may need to find an aide and/or access additional services.  Depending on the patient, specialty care physicians, visiting nurses, or other medical care may be necessary. 

If the discharged person needs an aide, finding one who is compatible will be a focus.  In the case of assisted living, the person’s mental capacity, physical state, and proximity to friends or family will all affect which facility is best suited for them, and how well they adjust to a new living situation.  Most assisted livings permit personal aides in their facilities.  Medicaid may cover home health aide services in an assisted living.

Issue #2:  Medication Management            

This is a thorny issue.  Home health aides are not permitted to administer medication.  They can put pills in a cup, place the cup on a table, and tell the person that “it’s time to take your pills,” but they can’t administer the pills directly.  For a person with dementia, or who has dressings that need to be changed, or physical procedures they can’t manage themselves, a home aide may not be enough.

Hiring a nurse to show up and give medications, or help with another physical need, is expensive, but it may be necessary.  One way to provide families with assistance instead of hiring a nurse is through the Consumer Directed Personal Assistance Program (“CDPAP”).  With CDPAP, aides hired by the family can be trained by the family, and then have fewer limitations on the care they are permitted to provide.

Issue #3:  A Home Safety Plan

Throw rugs, sharp corners, the path to the bathroom, poorly placed furniture, poor lighting – all of these and more can be a minefield of dangerous conditions, if you’re physically or mentally compromised. Fortunately, there are many printed and online resources and services that can help you create a safe living environment.

Issue #4:   Finding the Right Assistance

There are many excellent home health agencies.  The one the hospital recommends to you may be great – or it may not.  You may be happy with the agency, but if you are not, you can change.

It may take some effort to find an aide you are happy with – but that may not be the fault of the agency.  If you are unhappy with how the agency operates or manages your situation, find another agency.  Our firm’s Director of Client Care and Advocacy can give you a referral if you wish.

You may also choose to hire your own caregiver through the CDPAP program.  This choice requires more of your time and involvement than if you hire an agency, but will also give you added flexibility.

  If you decide to hire and pay your aide privately, we strongly advise against paying aides “off the books.”  There are a variety of serious issues and liabilities that can arise for the employer who does that.

Issue #5:   Does it Make Sense to Hire a Care Manager

If it is difficult for you to oversee the care, or if you don’t live nearby, you may wish to hire a Geriatric Care Manager (“GCM,” also sometimes called an Aging Life Care Manager).  A GCM can oversee the aides, check in with the patient, and generally manage the process.  The added cost needs to be weighed against the great peace of mind such a service can provide.

Issue #6:  How Will You Pay for the Care

Private pay aides currently cost $35-$40 an hour or more.   A hypothetical example for someone “who doesn’t need much care”:   6 hours a day, 5 days a week at $35 per hour (meaning all weekend care is left to family or friends) adds up to over $1,000 per week, almost $55,000 per year.  Double or triple that amount for people who need more help, or who need nursing care, or both.

No wonder people have anxiety attacks when they start paying for care.  They realize that even more expenses are on the horizon, and they see their life’s savings being depleted.  In the case of a married couple, they may have enough money to care for one spouse, but the surviving spouse may be left in serious financial peril.  If they don’t plan, most people literally face financial ruin. 

People are often told, “You have to use up all your money before you can qualify for Medicaid.  It’s called the spend down.”  This is not true, particularly in New York. 

Long-term care planning can allow you to remain in your home and maintain your lifestyle without using up almost every dollar of your savings, and the equity in your home, on your health care.  Proven legal strategies can allow you to protect yourself, your family, and your assets, and still access high quality health care.

The Bottom Line:

Our firm seeks to educate people about the possibilities available to them in New York.  If you own a home, have some savings, or have income from a pension or retirement plan in addition to Social Security, Elder Law planning can very likely result in huge benefits for your lifestyle, your savings, and your peace of mind.

Accessing care is complicated and stressful.  Lamson & Cutner created the position of Director of Client Care and Advocacy to enable us to assist our Elder Law and Estate Planning clients who need care services.  Our Director works with our clients to help them maximize the assistance they receive through Medicare and Medicaid.

If you or a loved one is in the hospital or a rehab facility, and have not yet done long-term care planning, discharge planning should kick-start your focus on this crucial aspect of your, or their, future.

We encourage you to read more on our website about Elder Law planning and Estate Planning, and to take action now.  Your relief and peace of mind from knowing you are protected will be well worth the effort.

The Corporate Transparency Act

Attention clients, former clients, and blog readers who own corporations, LLCs, or who have an interest in a trust that owns an LLC or corporation: major changes have been enacted through the Corporate Transparency Act that may affect you. This blog provides a brief description of the Corporate Transparency Act, its requirements, and what the consequences are for those who fail to comply.

AS OF JANUARY 1, 2024, MANY COMPANIES IN THE UNITED STATES ARE REQUIRED TO REPORT INFORMATION ABOUT THEIR BENEFICIAL OWNERS TO THE FEDERAL GOVERNMENT.

Which companies are required to report?

Companies that are required to report beneficial owner interests are called reporting companies. Reporting companies include corporations or LLCs registered to do business in the United States. Reporting companies must report information about their beneficial owners to FinCEN, a bureau of the U.S. Department of the Treasury.

Who is a Beneficial Owner?

A beneficial owner is any individual who, directly or indirectly, exercises substantial control over a reporting company, or owns or controls at least 25 percent of the ownership interests of a reporting company. For a trust that holds an ownership interest in a reporting company, the grantor, the trustee, or even the beneficiary may be considered the beneficial owner.

What Information Needs to be Reported to FinCEN?

Beneficial Owner:

  1. Full legal name
  2. Date of birth
  3. Complete current address
  4. Unique identifying number and issuing jurisdiction from one of the following non-expired documents (must include an image of the document):
    1. U.S. Passport
    1. State driver's license
    1. Identification document issued by a state, local government, or tribe
    1. Foreign passport (if the beneficial owner has none of the above)

When Must the Report be Filed?

If the reporting company was created or registered to do business before January 1, 2024, the company has until January 1, 2025, to file its initial report.

If the reporting company is created or registered on or after January 1, 2024, and before January 1, 2025, the company will have 90 calendar days to file its initial report after receiving actual or public notice that the company’s creation or registration is effective.

Failure to Comply:

The willful failure to report complete or updated beneficial ownership information to FinCEN, or the willful provision of or attempt to provide false or fraudulent beneficial ownership information may include civil penalties of up to $500 per day the violation continues, or criminal penalties of up to two years in prison and/or a fine of up to $10,000.   

Lamson & Cutner, P.C. Can Help!

The requirements imposed by the Corporate Transparency Act can be difficult to navigate and there are severe consequences for those who fail to comply. If you own an LLC, a corporation, or have a trust that holds an ownership interest in one of these entities, our firm can help you stay compliant with this new federal law. Contact us today for a consultation!   

Medicaid Asset Transfer Rules In New York

If you think you or a loved one may need to apply for Medicaid benefits in the future, it is important to understand the asset transfer rules.  Generally, gifts or transfers of money or property within the applicable “look back” period will subject the Medicaid applicant to a “penalty period” of ineligibility for benefits.  The attorneys at Lamson & Cutner can help clients understand the Medicaid asset transfer rules and qualify for Medicaid benefits, taking into account the recently-enacted Community Medicaid “look back” that is currently scheduled to go into effect in 2024.  Note:  The implementation date for the “look back” has been extended  to 2025, although a firm date has not yet been announced. Contact our firm to learn the current status of the Community Medicaid look back. 

Download our Estate Planning Handout

Medicaid Look Back Period Extended to Community-Based Services

Applications for Medicaid benefits in a skilled nursing facility are subject to the five-year nursing home look back period.  More information about the Nursing Home look back can be found here.   In 2020, New York State enacted (but has not yet implemented) legislation requiring – for the first time – a look back period for applications seeking in-home care or other Community Medicaid benefits.

The new look back period is 30 months.  However, due to the Public Health Emergency currently in effect, the States are not permitted to impose more restrictive Medicaid eligibility standards.  As a result, implementation of the new look back has been delayed until March 31, 2024, and it may be delayed further.  For New York's Medicaid system, the changes will require a tremendous amount of logistical preparation, as well as additional work, paperwork, and changes in procedures.

The new look back will mean that many patients and their families will incur substantial additional costs that were previously covered by Medicaid.  These may include the costs of adult day health care programs, private duty nursing services, certified home health agency services, assisted living program services, personal care services, limited license home care services, and managed long-term care services provided in a community setting.  The transfer penalty period will begin in the month when the applicant’s Medicaid application has been accepted, and the applicant has been approved for care based upon a functional assessment.  More information about the Community Medicaid look back is available here.

Understanding Medicaid Look Back Exemptions

People who want to apply for Medicaid can avoid a penalty period in cases where they are able to make an exempt transfer.  Medicaid asset exemptions and qualified exempt transfers are not subject to any Medicaid penalty, for either Medicaid Nursing Home benefits or Community Medicaid benefits.

Here is a list of exempt transfers that should be considered in appropriate cases:

Note:  Spousal refusal is not necessarily a 'free ride.'  Medicaid has the right to seek reimbursement from the spouse who refused, and in the past several years has done so with increasing frequency.  Fortunately, even when Medicaid seeks to be reimbursed, it does not mean that spousal refusal ‘didn’t work.’  The amount claimed will be for Medicaid’s costs, which are always less than private pay rates, and a compromise settlement can often be obtained.  In a typical case, the reimbursement amount is materially less than what would have been billed on a private pay basis.

In addition to the above, an exempt transfer of the primary residence can be made to any of the following:

We Can Help You Navigate Medicaid’s Asset Transfer Rules

The attorneys at Lamson & Cutner are dedicated to helping clients in NYC, Westchester, and the NY Metro area, understand and navigate the complex laws surrounding Medicaid eligibility.  We focus on health care and asset protection, helping client protect the assets, property, and income they have worked their entire lifetimes to accumulate.  Contact us today to schedule a no-obligation consultation with an experienced attorney.

The Pooled Income Trust – It’s Not As Complicated As You Think

If you or a loved one are thinking about accessing Medicaid for care in the community in New York City or its suburbs, you will also probably want to join a Pooled Income Trust.  The goal of using these trusts is to permit you to remain in your home as long as possible, by allowing you to continue to use your income to pay your expenses.

Why are Pooled Income Trusts needed?

Once you are over 65 and your assets are below the Medicaid threshold for a single person (the current level can be found on our Medicaid Quick Reference Chart - "MQRC"), you are eligible for Medicaid.  Your income is not a factor in whether you are eligible to receive Medicaid, but Medicaid does not ignore your income.   If you don’t plan, you will be required to contribute toward the cost of your care.

Once Medicaid is paying for your long-term care, the system has a built-in maximum amount of income that you are normally eligible to keep for yourself – again, the current level can be found on the Quick Reference Chart.  Any amount over that is called “surplus income,” and - unless you sign up for a Pooled Income Trust - the "surplus income" is required to be contributed toward the cost of your care.

In the New York City Metropolitan area in particular, living on the amount that Medicaid permits you to keep is rarely possible.  This is why New Yorkers receiving Medicaid benefits almost always turn to Pooled Income Trusts.

Download our Community Medicaid Handout

What is a Pooled Income Trust?

A Pooled Income Trust is a special kind of trust operated by certain nonprofit organizations.  These organizations manage Pooled Income Trusts as a service to persons who are disabled and as a way of generating funds for charitable purposes.  Examples in New York are UCS Trust Services and NYSARC Inc.

New York’s laws permit you as a Medicaid recipient to contribute your “surplus income” to your account at a Pooled Income Trust instead of contributing it toward the cost of your care if you are “disabled.”  The definition of “disabled” is a flexible one depending on age and health.  Most seniors who need home care will qualify.  As long as you are doing that, your income will not affect your Medicaid benefits.

How Do I Join a Pooled Income Trust?

When you are applying for Community Medicaid in New York, you would also join a Pooled Income Trust at the same time.  You need to sign a Joinder Agreement in order to establish your own personal account at the Trust.  The money you send to the Trust each month will be deposited into your personal account.

Each trust has its own procedures, and its own fee schedule – you should find the one that best suits your personal needs.  If you are using the services of an Elder Law firm, you should ask them for a recommendation.  The Elder Law firm will probably also help you fill out the paperwork to join, and advise you regarding the logistics of paying your bills through the Trust.

Once I Have Joined a Pooled Income Trust, How Do I Use It?

Your Pooled Income Trust account functions a lot like a bank account that someone else manages for you.  Each month you send your bills and receipts for items you have purchased for yourself to the Trust.  This can include rent, your mortgage, grocery bills, utility bills, phone bills, clothing purchases – pretty much any kind of goods or services, as long as they are for you and are not provided by government assistance programs.

The Trust needs to approve the expenses because Pooled Income Trust funds are only permitted to be used to pay for your own expenses.  Once the trust approves the expenditures, they pay your bills for you.

Isn’t it Complicated?

No, it doesn’t have to be.  Most people who need Community Medicaid have pretty similar bills each month.  The monthly non-discretionary bills can go directly to the Trust.  Then, for variable everyday expenses, it simplifies the process if you have a credit card that you can use for purchases that are for you.  The credit card bill can be submitted to the trust at the end of the month as well.

There is some paperwork involved, but our clients quickly get the hang of it.  Sometimes they need assistance if the Trust does not approve a purchase, but that’s one of the reasons they hired our firm in the first place.

How Did This Type of Trust Come About?

Pooled Income Trusts are permitted by law in order to allow disabled persons to supplement the care they receive from government assistance programs such as Medicaid.  It’s also a means of helping people stay in their own homes as long as possible.

Keeping people in their homes actually, saves the government money.  If a senior ends up in a nursing home, it is likely Medicaid that’s paying.  Even at Medicaid’s discounted rate, paying for nursing home care is almost always far more expensive than helping someone to stay in his or her own home.

Make a Pooled Income Trust work for you!  Call us today to begin your plan

What Happens to Your Income When You're in a Home?

Your monthly income, no matter how large or small, will not affect your eligibility for Medicaid Home Care.
However, Medicaid does not ignore income, and there is a limit to monthly
income. In 2020, the limit is $895 per month. If your income is above this
amount, you have “surplus income.”
When you have “surplus income,” you must either contribute it towards the cost
of your care, or deposit it each month into a Pooled Income Trust.
The Pooled Income Trust is specifically designed to protect your “surplus income.”
Using the funds you deposit, the trust will pay your normal living expenses, or for
anything else you need or want, including additional care above and beyond what
Medicaid is providing.
There are certain logistics involved in using a Pooled Income Trust. Also, there
are certain limitations: first, any payments or disbursements from your trust
account must be for your benefit, and not for anyone else. And second, any
money you don’t spend will go to charity if you move to a nursing home or you
pass on.

Download our Community Medicaid Handout