Services Offered
Chronic Care
NURSING HOME/LONG TERM CARE SERVICES
Placement in a nursing home from the hospital or home requires a client or their representative to apply for Chronic Care Medicaid. The Nursing Home Unit determines eligibility for Medicaid coverage for anyone who is confined to a nursing home or is accepted into our Long Term Care Program.
It is overwhelming when the representative sees the requirement list needed to determine eligibility. It is best if the representative has someone from our office go over the list with them. Sometimes this helps relieve some of the anxiety of coming in to apply for assistance. In many instances, this is the first time they have dealt with Social Services.
Most of our clients are disabled and cannot come into the office. We do not do home visits. Therefore, a designated representative must come in and provide the verification needed. They will need a notarized Authorization to Represent form or Power of Attorney before they can be seen. There are instances when the client is deceased, but still in need of assistance. In this case, Letters of Administration are needed from Surrogate’s Court in order to process the application.
Once an application is received at our office, we will contact the representative to set up an interview appointment. (This will be the date of application and if it is necessary we can go back three (3) months from that date if the applicant is eligible.) All of our appointments will be scheduled in the Lockport office at 20 East Avenue. Our office hours are 8:00 am to 4:00 pm, Monday through Friday.
The following is a list of documentation needed at the time of interview:
Birth Certificate/Naturalization Papers or Alien Registration Card – needed to determine U.S. citizenship
Marriage Certificate(s) – needed to show name changes
Divorce Papers/Death Certificate of Spouse – needed to show if there is a responsible relative
Armed Services Discharge papers – for applicant and/or spouse – there is an aid and attendance benefit available from the VA for nursing home residents if eligible. To find out more click here Department of Veteran's Affairs or call 438-4090.
Medicare Card and/or Health Insurance Card(s) – Proof of premiums paid by the client is needed - this is exempted from gross income when budgeting.
Proof of Residence prior to admission to nursing home. Applicants must be residents of Niagara County to be eligible in Niagara County. Assisted living residences such as Briarwood Manor, do not establish residency. Applicants will not be eligible if they move from a private residence in another state directly into a nursing home in NYS. Also, Medicaid does not transfer one state to another. If the applicant has been in a nursing home in Florida he/she cannot transfer to a NYS nursing home without permission from Florida Medicaid.
Letter/bill from Nursing Home – paid through date and Medicare cutoff date is needed to determine Medicaid opening date.
Deed to Burial Lot or statement from cemetery
Prepaid Irrevocable burial fund – contract, payment verification and current balance.
There is no income limit for nursing home coverage. The applicant’s entire income less a personal needs allowance of $50.00 and health insurance premiums is payable to the nursing home. In a case where there is a spouse living in the community the spouse is allowed to keep up to $2,267.00 of the combined income. Any income over this amount is payable to the nursing home.
INCOME VERIFICATION
Proof of gross income
Social Security
Pension or retirement
IRA or Annuity monthly payments
Workman’s Compensation
NYS Disability Insurance
Court Ordered Support Payments
Last eight (8) pay stubs or employer statement
The resource limit for an applicant is $3,850.00. If the applicant has a spouse, the spouse is allowed to have up to $74,820.00 in resources. The following is a list of resources that we will want information on.
RESOURCE VERIFICATION:
Life Insurance – proof of face AND cash values. If the total amount of the face values of is over $1,500.00, the cash value is considered a resource and will be counted towards the resource allowance. If the face values are less than $1,500.00, the cash values are an exempt resource.
Registration(s)/Title(s) – for all motor vehicles
Trust funds - original trust document with date of establishment. Verification of all transactions, principal and interest. There are many variables with trust funds so they will be referred to our attorney for review.
Real Estate – (homestead, vacation homes, vacant land, farm, rentals) – deed(s) to all property owned, including life use estates are needed. Single applicants can write a statement that they plan to return home. However, a lien will be drawn up by our resource department against the home. If there is a life use clause and the house is sold while the applicant is still alive, a portion of the sale will be payable to Social Services. If the home is rented out, the net rent (after expenses) will be used as income. All other property is considered a resource and will be counted at its assessed value.
Bank accounts (including CD, IRA, Mutual Fund, Credit Union accounts, Stocks, Bonds, and Securities) – statements from all accounts open or closed for 36 months prior to the application date. Any transactions (deposits and withdrawals) over $1,000.00 must be explained with verification. Penalties are assessed on all resources that are transferred or gifted. At present, the penalty is $5,614.00 per month beginning with the month after the transfer has taken place.
Annuities – original annuity contract and sixty (60) months of statements are needed. If the annuity is to be used as income it must be maximized into monthly payments based on the estimated life expectancy charts for the individual applying. Again explanations for any transactions over $1,000.00 must be explained.
Long Term Care services are provided in the client’s home, thereby avoiding most costly nursing home care. Referrals are made by home care agencies such as Niagara County Health Department or Visiting Nurses Association. Referrals must be made to the Long Term Care Unit in our Niagara Falls office. This program has the same resource and income eligibility requirements as the Nursing Home chronic care (Medicaid) program. - VISIT OUR HOME CARE SITE FOR MORE INFORMATION ON THE LONG TERM CARE PROGRAM.
RECERTIFICATION: Once a year we will contact the client or representative for recertification. At this time, we will need to update all income and resource information. We will need a completed recertification application and current information only: i.e. current bank/investment account statements, life insurance cash values, etc. and current income.
For more information or to get an application, contact Wendy at 439-7728.
For information on the Nursing Home of your choice, contact the Nursing Home. We have a list of Homes in our office.
