Nursing homes are only one option for the elderly. At Friends and Family Home Care we make it possible for you to get the care you need in the comfort of your home. Contact us at friendsfamilyhomecare.com to learn more about your options for home care.
As you or a loved one explore your options for long-term care, the last thing you should have to worry about is whether you can afford the support you deserve. Fortunately, Medicaid can likely cover part or all of the nursing home care costs you incur. To receive coverage, you’ll need to meet certain eligibility requirements, both financial and medical.
Even still, the amount you can expect Medicaid to pay depends on other unique circumstances. Understanding your options can help you make an informed choice about the best long-term care services for you.
- Medicaid can cover up to 100% of the cost of care for nursing home services.
- In New York, the income limit for Medicaid coverage is $2,523 each month. You must also have a limited amount of countable assets. Those who make more than this may still be eligible for some coverage, though it largely depends on other personal factors.
- Medical costs and Medicaid coverage differ depending on factors like location, the level of care, the care facility, and more.
- Those with disabilities who are 65 or older, have children, or have unique needs may also be eligible for partial or total coverage. Other options, like Medicare, may sometimes offer additional or supplemental coverage.
Does Medicaid Pay for Nursing Home Care in New York?
Good news: New York Medicaid can indeed cover a broad range of home care services. For nursing care, Medicaid coverage usually offsets part or even all of the costs you’re expected to pay. In New York, Medicaid covers 100% of the cost of nursing home care for eligible beneficiaries. To be eligible for this level of coverage, you must have a monthly income of $2,523 or less. There are also asset limits you have to satisfy.
There are some limitations to consider, though. Most notably, Medicaid will only cover the cost of a shared – not private – room unless a private room is deemed medically necessary. It’s also important to remember that healthcare provider rates differ from state to state. For instance, New York state averages ($435 per day of care) are generally higher than others (about $200-350).
How Much Does Medicaid Pay for Nursing Home in New York?
Medicaid reimbursement rates in New York range from around $120 to $800, depending on the facility. These rates detail the costs the program agrees to pay on behalf of beneficiaries.
Once Medicaid covers a significant portion of nursing home costs in the U.S., it generally gets to pay service providers lower rates than individual private payers would. On average, reimbursement rates are only about 70% of what private payers are expected to cover.
The exact amount that Medicaid will pay for nursing home care in New York depends on where in the state you or your loved one will be staying. It also depends on what type of nursing facility you pursue. The rates might also differ depending on whether you’re talking about standard Medicaid, Part B, Part D, or Part B & D rates.
Below is a brief preview of New York Medicaid reimbursement rates based on data provided by the State. Each facility’s rates show the amount you can expect Medicaid to cover based on your eligibility status. Be sure to visit the full list of facilities by county to help you decide which options might be right for you.
|County||Approximate Average Medicaid Rate|
|Albany||$175 – 300|
|Erie||$150 – 400|
|Kings||$200 – 600|
|Monroe||$200 – 400|
|Nassau||$250 – 800|
|New York||$300 – 1,000|
|Queens||$200 – 600|
|Westchester||$200 – 500|
Who Is Eligible for Medicaid Nursing Home Coverage in New York?
To consider your eligibility for Medicaid nursing home coverage, you’ll have to consider two main points: your income and your medical needs. Medicaid is designed to cover the costs of healthcare for low-income individuals. However, you also need to demonstrate medical necessity for the services you’re seeking coverage for.
In New York, as mentioned, you must make a monthly income of $2,523 or less to qualify for Medicaid coverage. Some other eligibility criteria to meet can include the following:
- The beneficiary must be a citizen of the United States or a qualified non-citizen.
- Beneficiaries must be residents of the state in which they receive Medicaid.
- Persons with disabilities, low-income families, pregnant people, and children may be eligible or face different eligibility requirements.
When applying, watch out for the look-back period, which is when Medicaid checks to see if you’ve parted with any valuable assets before trying to qualify for this type of health insurance. If it’s found out that you’ve transferred valuable assets like this, you may experience a penalty period, and you may no longer be eligible.
Nursing Home Costs in New York
In New York, the state average daily cost of a private room is around $435, while the average daily cost of a shared room is about $420. That means the overall annual cost of a shared room is a few thousand dollars less than a private room. The difference is potentially significant, depending on your budgetary needs, but overall not as large as you might expect.
|Average Nursing Home Costs in New York State|
|Private Room Cost (Daily)||Shared Room Cost (Daily)||Private Room Cost (Annual)||Shared Room Cost (Annual)|
While these figures may seem high, a skilled nursing home or facility employs staff, hosts many different services and offers around-the-clock care. As a result, the cost of a room can be somewhat significant, depending on the circumstances.
Fortunately, those who are eligible for Medicaid can receive consistent, reliable coverage that mitigates most or all of these costs. Older adults or those with disabilities, who are among the most likely to need nursing home care, are generally able to receive some level of public support.
Overall, New York’s Medicaid program is a reliable option for nursing home health care services. The state offers many options to make managing the cost of care manageable, whether you seek home care services or are interested in residing in a facility.
To get the best picture of your care costs, it’s best to select a facility and consider the type of care you’ll need. Take time to compare your options as you begin your Medicaid planning. There’s no shortage of options for prospective nursing home residents in New York. Once you’ve been approved for coverage, you can get a truer sense of what you’ll need to pay – and what you don’t.