Frequently Asked Questions
- How can I tell if my policy is a Partnership policy?
- If I have an illness, can I still qualify for the Partnership?
- I am planning to move out of New York State. Can my Partnership policy cover me in other states?
- I am planning to move to a non-Partnership state and have no plan to come back to New York. Is a Partnership policy good for me?
- As the owner of a Partnership insurance policy, am I able to receive care in any nursing home facility in New York State? Do all nursing facilities in New York accept Medicaid?
- What is Medical Assistance?
- How can I find out more about Medicaid?
- What health services are covered by Medicaid?
- How do I apply for Medicaid?
- If I can't leave the house, can I still apply for Medicaid?
- When Medicaid evaluates me for eligibility under the Partnership, what documentation will be required?
- If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have?
- Can I still keep part of my income if I am in a nursing home (Residential Health Care Facility)?
- I have a long-term care policy which is not a Partnership policy but has the same coverage as Partnership insurance offers. Can I access Medicaid without spending down my resources after my policy's minimum benefit duration period is exhausted?
- When I become Medicaid eligible after my policy's minimum benefit duration period is exhausted, will Medicaid provide the same home care services I have been receiving under my private insurance portion of the Partnership coverage?
Make sure the Partnership logo appears on your policy. All Partnership policies should have the Partnership logo on the front page of the insurance policy and other materials related to it.
Most insurers who sell long-term care insurance use medical underwriting to determine if they will sell you a long-term care insurance policy. Medical underwriting is a process through which insurance companies review a number of factors including your health history. Insurance companies use the information gathered during the underwriting process to determine if they will provide long-term care coverage. Long-term care insurers are not required to sell you a long-term care insurance policy if you do not meet their underwriting standards.
Your Partnership policy has two components: a private insurance component and the Medicaid Extended Coverage component. During the private component, you can use your policy's benefits wherever you choose (in accordance with the policy contract conditions). During the Medicaid Extended Coverage component, you must be a New York State resident in order to receive New York State Medicaid Extended Coverage.
I am planning to move to a non-Partnership state and have no plan to come back to New York. Is a Partnership policy good for me?
If you relocate out of New York State, you would not be eligible for Medicaid Extended Coverage unless you return to New York as a resident. Therefore, if you plan to relocate out of New York State with no intention of returning, you might want to consider buying a comprehensive, non-Partnership policy. However, you should keep two important considerations in mind:
- New Yorkers who become ill or disabled often return to New York State (even if they had no intention of doing so initially) for a variety of reasons, including the circumstance that they often have relatives in New York whom they wish to be near.
- If you buy a non-Partnership policy, you must think about the issue of benefit duration. If you buy a traditional policy with a coverage term less than lifetime, you run the risk of paying out of pocket for any period of care beyond the coverage term. (For example, if you buy a 5-year coverage term and need a 7-year nursing home stay, you will pay out-of-pocket for the last 2 years of care). Therefore, comprehensive long-term care insurance coverage to protect you outside New York State would be a policy which includes a lifetime benefit duration, inflation protection and nursing home and home care benefits.
As the owner of a Partnership insurance policy, am I able to receive care in any nursing home facility in New York State? Do all nursing facilities in New York accept Medicaid?
As a reminder, your insurance contract entitles you to use your private insurance benefits anywhere your contract permits, whether in New York State or elsewhere. That being said, it is important for you to know that a small number of nursing facilities in New York State do not accept Medicaid. These facilities accept only Medicare reimbursement and/or private payments, including private insurance. Consequently, while Partnership program participants may receive care in these facilities as Medicare/private-pay/private-insurance patients, Medicaid Extended Coverage will not be accepted as reimbursement for services in one of these facilities after the Partnership private insurance coverage period ends.
Therefore, it is important for Partnership program participants to be knowledgeable about such circumstances when choosing nursing facilities. In order to make an informed decision about your care setting it is recommended that you know beforehand which methods of payment and/or reimbursement are accepted by a particular nursing facility.
Medical Assistance is known as Medicaid, a program for New Yorkers who can't afford to pay for medical care by themselves.
You can access the Medicaid Reference Guide at the NYS Department of Health Website or call your local Department of Social Services (see list of local Department of Social Services phone numbers) to learn more about Medicaid eligibility rules.
In general, Medicaid pays for the following services, except in certain cases dependingon age, family situation, or living arrangements:
- hospital inpatient and outpatient services
- laboratory and X-ray services
- care in a nursing home
- care through home health agencies and personal care
- treatment and preventive health and dental care (physicians and dentists)
- treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
- family planning services
- early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
- medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
- clinic services
- transportation to medical appointments, including bus tokens and car mileage
- emergency ambulance transportation to a hospital
- prenatal care
- other health services
*Services must be from Medicaid providers. Not all providers accept Medicaid.
If you are eligible for Medicaid, generally you will receive a New York State Common Benefit Identification Card to use when you need medical services. There may be limitations on certain services. In order to use your Common Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must receive prior approval before the service can be provided.
You or someone on your behalf can apply for Medicaid in the following ways:
- Write, phone, or go to your local Department of Social Services. Here is a List of local Department of Social Services phone numbers at the New York State Department of Health website.
- In New York City, contact the Human Resources Administration by calling 1-877-472-8411 (toll free within the 5 boroughs).
- If you are a resident in a facility operated by the New York State Office of Mental Health, contact the resident resource office of the facility.
- If you are a resident in a facility certified by the New York State Office of Mental Retardation and Developmental Disabilities, contact the revenue and reimbursement office of the facility.
Yes. Call your Local Department of Social Services and ask for assistance.
When Medicaid evaluates me for eligibility under the Partnership, what documentation will be required?
- A letter from your Partnership insurer indicating that you will have used up the minimum amount of benefits under your policy certificate within approximately 90 days of continued benefit use, at which time you may qualify for Medicaid Extended Coverage under the Partnership.
- Proof of identity, such as a birth certificate.
- Proof of citizenship or satisfactory immigration status.
- Recent paycheck stubs (if you or your spouse is working).
- Proof of your income from all sources such as Social Security, Supplemental Security Income, Veterans Administration, retirement, investments, rental property, etc. (See Medicaid Eligibility and the Treatment of Income and Assets under the New York State Partnership for Long-Term Care)
- Proof of where you live, such as a copy of a rent receipt or landlord statement or billing statement in the case of residing in a long-term care residential facility.
- Health insurance benefit card or the policy.
- Proof of all resources (assets) (including bank accounts, investment accounts, real estate property, life insurance, business property, etc.) if you have a Dollar for Dollar Asset Protection Partnership policy.
If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have?
No. Wait and discuss this question at your local Department of Social Services interview.
Yes. Under Medicaid, you are allowed to keep a monthly amount of $50 for your personal needs. You can also keep some of your income for your family if they are dependent on you. A spouse who remains in the community and is married to an institutionalized spouse may also keep income according to the spousal income rules.
I have a long-term care policy which is not a Partnership policy but has the same coverage as the Partnership offers. Can I access Medicaid without spending down my resources (assets) after my policy's minimum benefit period is exhausted?
No. The only policies which qualify for resource protection under the Medicaid program are Partnership policies. Every Partnership policy carries the Partnership logo.
When I become Medicaid eligible after my policy's minimum benefit duration period is exhausted, will Medicaid provide the same home care services I have been receiving under my private insurance portion of the Partnership coverage?
When you apply for home care under Medicaid Extended Coverage, you will be assessed for your home care needs by your Local Social Services Department (LDSS) based on a number of factors. While there are no guarantees regarding the frequency and specific services you may be determined eligible to receive under Medicaid, the LDSS assessment process will take into account your level of disability, your care needs, any available support systems present (or absent) in your situation, and the services you are or have been receiving under your private insurance coverage.