New York City and Medicaid Subsidized Home Health Care

(6/22/11)- Medicaid costs the federal government and states about $400 billion a year and covers 68 million Americans. Along with the Children's Health Insurance Program, it covers about one in four Americans. States will be faced with a cut of $26 billion from the federal government in July under an extra funding allowance that will be discontinued.

Medicaid is most likely to be one of the targets to face cuts as a result of the budget negotiations now going on between Vice-president Joe Biden and the 6-member Congressional debt ceiling increase committee.

(2/7/09)- In 1988, Congress passed a law that was intended to protect healthy spouses with lower incomes and fewer independent assets from being impoverished by the cost of long-term care for his/her spouse. New York State extended that same benefit to people with illnesses such as Alzheimer's disease or cancer who receive care at home, rather than in a nursing home.

Recently federal Centers for Medicare and Medicaid Services (CMS) officials have ruled that the state was too generous in this interpretation of the law. Under this ruling the spouse must go to a nursing home, rather than continue to be cared for at home, or else the healthy spouse must contribute towards the upkeep of the sick spouse at home. The change was to take place in December 2008, but the New York Congressional delegation and Governor Patterson have won a delay from enforcement of the ruling until March 1.

President Barack Obama's administration has not indicated, as of this date, whether or not it would alter this ruling. The letter from the CMS officials was sent to state health officials in the fall of 2008 outlined a legal ruling that declared that couples in which both partners lived at home are not entitled to the same protection as when one of them is residing in a nursing home.

"They're saying if you put your spouse in a nursing home, you're going to keep more income than if you keep your spouse out of a nursing home," said Mark Kissinger, deputy commissioner of long-term care for the state Health Department. "That's completely opposite to public policy and research of the last 10 years."

(6/11/04)- Under New York Medicaid rules recipients have to surrender excess Social Security payments over a set maximum of their subsidized payments from Medicaid for a home-health care worker. Betsy J. Segal, an administrative law judge with the State's Department of Health ruled that money in excess of the maximum can be left in a separate trust for the recipient as long as the trust was used specifically to pay the individual's rent, food and other daily living expenses.

In New York City, the Human Resources Administration oversees the Medicaid program. In the case in question, an elderly New Yorker who was identified only as M.O. was ordered to pay the difference between his Social Security check and the maximum that the agency deemed allowable before any excess had to go to the cost of his home-health care worker. In his case he received a Social Security check for $1,078.70 which was well above the $642 maximum for subsidized visits for the worker.

According to M.O.'s lawyer, Aytan Y. Bellin, the rent on his apartment was $2,160.51. Even though his former wife was helping out with some of his expenses, the man would not be able to live at home on just $642 a month. In effect the $358.01 that could be spent towards his rent and food would help towards keeping him at home instead of having to go to a nursing home. By keeping him out of a nursing home, Mr Belin stated that the city was in effect saving a lot of money since on average, according to Mr. Bellin in speaking about Medicaid: "But they'll allow you to move into a nursing home where they'll be paying, on average in New York, $8,695 per month."

M.O. suffered from dementia and needs 12 hours of home health aid a day. The excess of $358.01 was placed in a trust administered by Nysarc, a nonprofit group that provides services for the disabled in New York. Mr. Bellin argued that federal law allows Medicaid recipients to shelter some income in a trust as long as it goes towards basics such as rent, food, electrical and gas bills and telephone services.

In 2000 there were 630,557 people 65 or older in New York y with reported incomes of $18,000 or less, according to an analysis of Census Bureau figures by the Queens College Department of Sociology. It is uncertain as to whether or not the ruling applies to the rest of New York state.


By Allan Rubin
updated June 22, 2011

Return to Home