Medicaid & the Partnership
The Partnership is a unique and innovative program promoting shared responsibility for financing long-term care by linking private insurance to Medicaid.
Medicaid Extended Coverage
Medicaid coverage under the NYS Partnership is called Medicaid Extended Coverage. Eligibility for Medicaid Extended Coverage is based upon time. Individuals who purchase Partnership policies, subsequently use the benefits according to the conditions of the program, including the duration requirements, may apply for Medicaid Extended Coverage.
Qualifying for Medicaid under the Partnership
In New York, people may qualify for Medicaid Extended Coverage under the Partnership when their medical and long-term care bills exceed their ability to pay for their care according to Medicaid income and resource rules.
An insured with a Total Asset Protection plan may apply for Medicaid Extended Coverage with protection of any amount of resources (assets) and is therefore exempt from any penalty associated with the transfer of resources (assets). With a Total Asset Protection plan, the insured may sell, transfer, and/or spend resources (assets) before, during, and after applying for Medicaid Extended Coverage without affecting his/her eligibility for Medicaid as long as he/she exhausts the policy minimum duration period.
An insured with a Dollar for Dollar Asset Protection plan may apply for Medicaid Extended Coverage without regard to resources (assets) equal to the amount of insurance benefits paid out under his/her Partnership insurance plan as long as the policy minimum duration period is satisfied. However, any amount of unprotected resources (assets) in excess of the allowable Medicaid resource level as well as transfers for an uncompensated value may affect your eligibility for Medicaid Extended Coverage.
Although Medicaid does not consider protected resources (assets) in determining eligibility for Medicaid Extended Coverage, an applicant's eligibility is determined based on unprotected resources (assets), income, and the cost of the care received. Therefore, if your income is too high and/or your unprotected resources (assets) are in excess of allowable Medicaid resource levels, you may not qualify for Medicaid Extended Coverage.
The following chart shows how much income and unprotected resources (assets) you can keep and still qualify for Medicaid for home and community-based care. The income and resource (asset) level depends on the number of persons in the household.
|Household Size||Monthly Income||Annual Income||Resources (Assets)*|
In addition to the income levels for home and community-based care, Medicaid allows a nursing home resident to keep $50 a month of income. An at-home spouse of a nursing home resident can keep at least $2,841 a month of income. If the at-home spouse's income is less than $2,841 a month, an amount will be subtracted from the nursing home spouse's income in order to provide this amount.
If the at-home or community spouse's income is greater than $2,841 a month, then Medicaid requests that she/he contribute 25% of the amount over $2,841 toward the cost of his/her spouse's care. (See Medicaid Eligibility and the Treatment of Income and Assets Under the New York State Partnership.) 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.
- Frequently Asked Questions
- Medicaid Reference Guide at the NYS Department of Health Website
- Medicaid Program - Important Phone Numbers at the NYS Department of Health Website