1. Who we are
We help families understand the options available in the event of an
illness that may require nursing home care or home care. For those
already in a nursing home or assisted living facility, there are usually still
asset protection options available. We will review those options and help
families through the process of spending down and applying for
Medicaid. We also refer to and work with other professionals as needed
such as an Elder Law Attorney, Financial Planner or Accountant. Audrey
Toussaint has worked as an Estate and Medicaid Planning Paralegal for
over 20 years and a Trust Officer for 8 eight years.
Contact Us
Audrey Toussaint
6 Mohawk Trail
Clifton Park, NY 12065
(518) 280-9855 – Office
(518) 813-8913 - Cell
Email: atoussaint5253@gmail.com
www.nscfs.com
North Star Consulting & Fiduciary Services, LLC
6 Mohawk Trail
Medicaid and
the Medicaid
Application
Process
Paying for Nursing Home or Home Care
Guiding you through the Ages

2. How do I pay for Long Term Care?
Paying for care in a nursing home or at home is devastating
for a family. Nursing home care can cost upwards of $13,000
per month. Home care can cost just as much. Traditional
health insurance and Medicare do not pay for Long Term
Care. In fact, there are limited options on how to pay for
Long Term Care. If healthy, Long Term Care Insurance is an
option. A life insurance policy with a Long Term Care Rider
is also an option for people in good health. Another option
is private paying (using your own funds) until you are out of
money or pass away, whichever comes first. Once out of
money, or if you have properly planned, Medicaid will pay
for the cost of Long Term Care.
What is Medicaid?
Medicaid is joint Federal-State program. It provides medical
assistance to eligible needy persons. Unlike Medicare, it is
an entitlement program based on income and asset
guidelines. You must qualify for Medicaid in order to receive
services. The New York State Department of Social Services
rules the program, which is administered by Counties. Each
County in New York State has a local Department of Social
Services. You apply for Medicaid in the County where you
reside or resided prior to nursing home placement.
Services
Medicaid Application
∑ Review ownership of assets
∑ Gather all documents, Evaluate the
value of any transfers made and
determine the penalty period
∑ Review all assets and trace deposits
and withdrawals
∑ Advise on allowable expenditures
during the Spend-down period
∑ Conduct the Face-to-Face Interview
∑ Prepare all forms (i.e. Medicaid
Application, Authorizations,
Affidavits)
∑ Assistance with Nursing Home
Applications
Asset Protection & Referrals to Professionals
We assist families in making transfers to a
Medicaid qualifying Trust to protect assets,
we monitor transfers and determine penalty
periods.
All Trusts and other Estate Planning
documents must be prepared by an Elder
Law Attorney
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3. Eligibility Levels CONT’D
keep so much of the institutionalized spouse’s income to
bring him/her up to that level.
The Community Spouse Resource Allowance (CSRA) for
2015 is a minimum of $74,820 and a maximum of $119,220.
The Family Home
The Family Home is an exempt asset as long as the applicant
or spouse is living in it. In the event the applicant or spouse
is not living in the house, it will be considered an available
resource.
An applicant may claim an “Intent to Return Home” and the
house would continue to be exempt but Medicaid will place
a lien on the property.
An Exempt transfer of the home may be made to select
individuals and should be reviewed on a case-by-case basis.
Asset Protection
Even if someone is already in a nursing home, it may be
possible to protect a portion of their assets with the use of a
properly drawn Promissory Note.
It is never too late to protect assets!!
Applying For Medicaid
The Medicaid applicant must be at or below the Medicaid
resource level by the first day of the month of requested
eligibility. For instance, if someone is applying for Medicaid
coverage as of June 1, they must be at or below the resource
level by May 31. The cost of a prepaid funeral and medical
bills are the only deductions allowed after that date.
Medicaid coverage can be requested to pay medical bills
incurred up to three months prior to the application date, as
long as the applicant was eligible at that time.
A Social Welfare Examiner will conduct a face-to-face
interview with the applicant or their representative and all
necessary documentation should be submitted at this time.
A Determination on the application is supposed to be made
within 45 days.
The most important part of the application is to be sure the
applicant is eligible.
A mishandled Medicaid application can cost
tens of thousands of dollars!
We know the rules and regulations and have the expertise
to handle Medicaid applications in a professional, timely and
efficient manner.
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4. What Do I Need?
There is a lot of documentation that is required to be
submitted with a Medicaid application. In the event the
applicant is married, documentation will need to be
submitted for both spouses.
∑ Verification of Birth, Citizenship & Photo ID
∑ Medicare, Social Security and Health Insurance cards
along with current premiums
∑ Verification of Marital Status
∑ Veteran’s Discharge papers
∑ Verification of Income from all sources
∑ All Estate Planning Documents
∑ Statements on all accounts back 5 years from the
date of requested eligibility, along with copies of
checks for withdrawals and deposits in the amount
of $1,000 or more
∑ Titles to any motor vehicles or mobile homes
∑ Tax Returns and 1099’s for the past 5 years
∑ Residency verification
∑ Deed and tax bills for any property owned
∑ Contract of sale of any property sold within 5 years
∑ Burial plot deed
∑ Life Insurance policies with current cash values
Any unexplained withdrawal may either cause a denial or a penalty
period where Medicaid will not pay!
Eligibility Levels
Home Care:
2015 Income & Resource Levels
(for applicants over 65 years of age or disabled)
Income Resources
Single Person $ 845 $14,850
Married Couple $1,229 $21,750
The Applicant may also have:
∑ The family home, as long as the applicant or spouse
is living in it
∑ $1,500 face value of Life Insurance
∑ Prepaid funeral held in an Irrevocable Trust account
∑ A car
Nursing Home Care:
The Applicant can have up to $14,850 in Resources. If single,
all Income except for $50 per month will go to the nursing
home.
If married, the spouse in the community (the Community
Spouse) can keep up to $2,980.50 per month in income
(Minimum Monthly Needs Allowance – MMNA). In the event
the Community Spouse has less than $2,980.50, he/she may
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