Paying for Care: You May Not Have To

In New York City, it is possible to get substantial assistance in paying for the majority of the cost of home care. New York City has the most generous Medicaid home care program in the country. It is even possible that one can go to an assisted living facility and have Medicaid pay for "home care" in that facility, if the family pays the rent. With these home care and assisted living facility options, placement in a nursing home can be avoided.

"With the right guidance it is very possible to obtain assistance from Medicaid in paying for home care, even if is 24-hour around the clock care."

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"My Dad just had a stroke, and he’s in the hospital. I guess I always knew this day would come, but, here we are, and I really don’t know what we’re going to do. He has lived on his own for 10 years since Mom died; he’s 87. He lives in a big old house in Brooklyn, which he couldn’t take care of before. But he has always done things his way. He thinks he’s going to march out of the hospital and pick up where he was before, but the doctor tells me, at best, he’ll be able to walk with a walker, and I haven’t even seen him get out of bed yet. I really don’t know how to determine what his needs will be, where I’m going to get the help from, and is Medicare going to pay for it? I have to get an aide that knows how to deal with my father, or he’ll throw them right out."

How Is Care Paid For?

When we ask “How is care paid for?”, we are referring to the care that a person needs to stay safe in her own home or apartment. This is commonly referred to as “home care.” Of course we may also want to know how care is paid for in an assisted living facility, rehabilitation center, or nursing home. The point is that the first place that care is needed is usually at home. People usually don’t go from being totally independent/self-sufficient to needing to live in a facility.


Medicare is the insurance most seniors receive at age 65 upon retirement if they have paid into Social Security while they or their spouse were working. It is primarily a health insurance, with minimal coverage for home health care. Many people are surprised to learn that Medicare provides very little assistance in paying for care in one’s own home. The amount of help rarely exceeds 4 hours/5 days per week, is often less than that, and is not based solely on need. It does not even pay for prescriptions. Many seniors then enroll in Medicare HMOs, which entice people because the plans have coverage for prescriptions.

Typically, Medicare becomes a senior’s primary health insurance when they retire. If they choose not to join a Medicare HMO, which requires that they see doctors in that plan’s particular network, then it is a good idea to pay for a supplemental insurance to cover, typically, the 20% of doctor’s visits that Medicare doesn’t cover (and other copays). These plans are also known as Medigap policies, and a senior is usually in pretty good shape as far as health insurance coverage is concerned, if they have Medicare and one of these Medigap policies. But again, there is no home care benefit.

Long-Term Care Insurance

Long-Term Care Insurance is a great thing to have for home care coverage, but it is costly, and if you have come to this website, then it is most likely too late for this to be an option. One can’t obtain long term care insurance at the point that he needs care.


Then there is Medicaid. In the five Boroughs of New York City, it is very possible, with the right guidance, to access Medicaid and to obtain the amount of hours of home care per day that are needed, even if 24-hour care is needed. New York City has the most generous Medicaid home care program in the country. It is generous for two reasons: i. There is no transfer of assets penalty for Community Medicaid. Community Medicaid covers care in one's own home. (Although a Transfer of Assets penalty exists for Nursing Home Medicaid, it is still possible to preserve a good portion of assets.) ii. It is possible to obtain 24 hour care in one's own home, 7 days per week (even two 12 hour shifts per day).

Consultation with an elder law attorney is highly recommended for Medicaid planning purposes. I can refer you to a highly qualified elder law attorney, who will ensure that the proper financial planning has been done. Then, I handle the filing of the Medicaid/Home care application process.

Clients may be able to keep home care aides whom they’ve become fond of and still have Medicaid pay. This would require the following: that the aide can document legal immigration status, that she is willing to be paid by check and have taxes taken out of her pay by a Medicaid agency, and that she passes a physical. I can also help find home care aides who start out privately paid and then remain with the client once Medicaid starts paying, so that the care recipient does not have to get used to a new person or persons.

It is possible to obtain individual home health aide services paid by Medicaid while living at an assisted living facility, as long as the family pays the rent, which in New York City is in the $3000 to $4000/month range. Often this can be done from the assets that have been transferred. The rationale behind this is to get the social contact and hotel-style living that these places provide, while still getting the one to one care that many individuals need. Without Medicaid, one to one care in such a facility would probably at least double the cost. It should be noted that even then the cost would be less than the cost of a nursing home.


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