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What does Medicaid cover? Will Medicaid pay my past due bills? Can I keep my doctor

Medicaid can pay for hospital care, doctor, dentist, and prescription costs. It may also pay for health care aides in your home and nursing home costs. Medicaid can cover bills retroactive for the three months prior to your application if you were eligible in those months. In order for Medicaid to pay on any bills, your doctor or hospital must be an enrolled Medicaid provider. You should check with your doctor to see if he/she is a Medicaid provider.

What if I can't find all the information that's needed for the interview?

You are given a period of time to gather any information needed after the interview is completed, usually two weeks. You can request an extension of time if you find you need it. In order for the examiner to be able to make an eligibility decision on your application as soon as possible, please try to bring as much information as possible to the interview.

What kind of information is needed for an interview?

You can request a copy of Documentation needed for an Interview for a complete listing. You should keep 3 years of records for all banks and financial institution accounts that you have including IRA'a, annuities, trusts, etc. Monthly statements are required for each account owned, whether still open or closed during the 36 month review period (question #9). Requesting
replacements of statements can be costly as banks have a fee for that service. If the application is not for nursing home level of care, only the current month's statement is needed for all resources.

What is a 36 month review? What does a resource review mean?

NYS Medicaid regulations state that any application for Medicaid for nursing home level of care requires a review of income and resources of the applicant ( and their spouse) for the 36 months (3 years) prior to the application. For example, if an application is made in February 2002, the resource review starts February 1, 1999 and all resources owned beginning from that date and during the next 3 years are examined and reviewed.

What is a spenddown?

In question #3 income levels were shown. If a households income is higher than the allowed level shown, they can "spend down" their income each month to the allowed level with a medical expense and Medicaid can pay remaining outstanding medical bills in that month. For example, if a single person has Social Security income of $700 per month, they would need to "spend down" $75 each month to be eligible for Medicaid that month.

What can I give away? Can I give anything away?

If you have given away resources for less than fair market value and you make an application for nursing home care within 36 months of that transfer, it could affect your eligibility for certain types of care that medical assistance may cover. Please ask for Informational Notice transfers of Assets for more information. You may wish to contact an attorney for additional information concerning transfers of assets.

What are countable resources?

Resources are different from income. Some examples of resources include cash, bank accounts, stocks, bonds, IRA's and property. Other potential resources may be explored when you apply. The resources you are allowed to have while receiving Medicaid are exempt during our lifetime. This means that DSS cannot make you use them for your care. However, upon death, the balance becomes a part of your estate and is used to help pay your creditors, including the Department of Health and Human Services.

What is spousal impoverishment?

This is a program under NYS Medicaid that allows higher income and resource levels for married couples, one of whom requires nursing home care, while the other remains in the community. The community spouse can keep income and resources up to the levels listed below $2,232 (monthly Income - level for 2002) and countable resources of $74,820. These figures are counting the combined income and resources for the couple whether held jointly with the spouse or any other person, or singly.