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Understanding Medicaid Home Care Benefits And Eligibility


As of October 1, 2020, new applicants for Home Care Benefits from Medicaid in New York City will be subject to a financial look-back period of 2.5 years during submission. Applicants before this time will be exempt from the look-back.

Home care benefits are simple enough to understand: If Medicaid determines that a person qualifies for help around the house, that care is provided. Unfortunately, confusion surrounding these benefits either drives people out of their homes and into care facilities or leaves them home without the help they deserve.

At The Law Offices of Polizzotto & Polizzotto, LLC, our accumulated knowledge and experience working with Medicaid allow our attorneys to clear the confusion and facilitate the delivery of much-needed care.

Who Is Eligible?

An evaluation of a person’s medical and financial need is used to determine eligibility.

  • Medical eligibility — To qualify medically, a person must be defined as disabled. The disability must be expected to last for at least one year and prevent the person from participating in gainful employment.
  • Financial eligibility — In our experience, this is one area where people assume that they do not meet the threshold for being low income. Many people do not realize that New York allows those who exceed the monthly income limit to place the excess in a pooled income trust that can be used to pay for care expenses.

Is There A Look-Back Period?

While Medicaid requires a five-year look-back period for nursing home benefits, no look-back period exists for home care benefits in the state of New York. Applicants for home care need not worry about any gifts or transfers of assets made prior to applying.

How Long Does The Process Take?

Without complications, the whole process can be as short as one month.

What services are provided with home care benefits?

Depending on your individual plan of care, here are some of the in-home services provided:

  • Part-time or intermittent in-home health care
  • Physical therapy
  • Occupational therapy

If your individual plan of care includes any of the above services and you qualify for assistance with basic cleaning and personal care services, those may also be included in your care plan.

Contact a Medicaid benefits lawyer who can help clear up any confusion and provide you with an assessment of your case.