NYS Medicaid Spend Down? (New York, York: health insurance, house, income)

[yodel]

I wonder if there's anyone in the New York forum that can help me understand this. My sister, who is seriously ill, recently relocated from MD to NY since she is not able to live on her own anymore. I was under the impression that her insurance would provide assistance in the form of physical therapy, and a home health attendant, but was told that this is something that she would have to pay out of pocket for unless she participated in something called the Medicaid Spend Down program. I'm really confused about this. From what I read online, she may not be eligible since she has assets and an income that is considered too high for the program. She has no children and is in her 40s. If anyone can help, I'd appreciate it.

[skeeter31]

If she doesn't have other health insurance and is relying upon Medicaid for her health care, her income needs to be below a certain amount each month. If her income is above that amount, she must "spend down" (ie pay to the county) the amount of her monthly income that is above the Medicaid income level. For example (using even numbers which are NOT the correct numbers):

Medicaid Income level: $800.00
Her monthly income: $1,000.00

In order to have Medicaid coverage for the current month, she would need to pay her county's Social Secrvices Department $200.00. Once the county receives that money they would activate coverage for that month.

If she needed hospitalization coverage, she would need to meet a spend-down equal to 6 months. So using the above numbers, she would need to pay $1,200.00 in order to be covered for an in-patient hospitalization.

Hope that helps.

[yodel]

Thank you for your reply skeeter. She actually does have health insurance that she pays for, but it doesn't provide a lot of services. Her insurance does not cover a home health aide or physical therapy, which she really needs. The visiting nurse said that she thought that my sister should go on this program sooner or later since the out of pocket costs may be more than the money paid to Medicaid soon (her illness is terminal and she will need more and more care).

But she also owns a house and has some assets, so I'm unclear about whether she'd qualify for this anyway. I guess I should speak to one of the social workers at the doctor's office next time I'm there, but wanted to find out as much info as possible beforehand. I'm surprised that private insurance seems to offer so little help when you need it most.