Elder Law Is for Everyone Part 2: Medicaid Homecare

Often, people with long-term medical or cognitive conditions that limit their ability to manage their daily care need in-home assistance. Since home care typically costs between $25 and $35 an hour, without long-term care insurance, home care is unaffordable or financially devastating for many.

Subject to eligibility, New York Community-based Medicaid (Homecare) is a solution.

Homecare eligibility rests on three factors: (1) assets eligibility; (2) assistance needed for at least two activities of daily living (ADLs); and (3) Monthly Income Budgeting.

In 2025, to qualify for Homecare, the applicant must have countable assets below $32,396 and the non-applying spouse can have assets up to $157,920.

The first step to obtain Homecare benefits is to submit a Medicaid application. After Medicaid ascertains that the applicant is financially eligible, it determines how many hours of care it will pay for.

The next hurdle is to meet the Income Budget. The applicant’s gross monthly income minus their Medicare premiums is their Income Budget. The 2025 individual Monthly Income Budget is $1,800. Any excess income can be assigned to a Pooled Income Trust. The Pooled Income Trust then pays bills such as rent, groceries, credit cards, taxes, and utilities.

The spouse can sign a spousal refusal, requiring Medicaid to consider only the applicant’s assets and income. If a spousal refusal is used, the spouse faces a potential lawsuit to recover the cost of care.

Up to $1,097,000 in home equity is exempt for Medicaid purposes, but the 2025 median sale price in Lloyd Harbor was approximately $2.8 million. One way to create eligibility for Medicaid Homecare is to create a special asset protection trust or income only trust, and transfer title of the home to the trust. If the transfer to the trust is completed outside of any applicable lookback period, the house will be a protected, unavailable asset even if the equity exceeds the exemption limit. The need for spousal refusal can be reduced or eliminated through advance planning, including the establishment of asset protection trusts by the spouse.

The Medicaid rules are complicated. A caring, experienced elder law attorney can help implement a plan that fits your life.

This article appeared in the December 2025 issue of Stroll Lloyd Harbor.