Nursing Home Care, In-Home Care, and Medicaid Planning

Nursing Home Care and Medicaid Planning

Quality nursing home care can cost over $15,000 per month and can potentially deplete your family’s life savings in no time unless you make a plan with an experienced elder care law attorney.

Many people ask, “Why should I work with an elder law attorney?”  First, it is important to make sure that the Medicaid applicant is eligible for Medicaid. If there are excess resources, transfers during the last five (5) years or a community spouse, planning must be done which usually involves the practice of law. If an application is submitted before troubleshooting all issues, the application could be denied resulting in a large private pay bill due to the nursing home care.  For instance, there is a penalty period for transfers made to anyone other than a spouse during the five (5) years prior to applying for nursing home Medicaid. Generally, this means that Medicaid will not pay for a period of time-based on the amount of funds transferred. If transfers were made it is imperative that an elder law attorney be consulted to discuss ways to address the transfers before a penalty period is imposed.  There is no penalty for transfers between spouses.

Second, Medicaid planning does not stop with the filing of a Medicaid application.  It is important to understand the implications of the planning and to makes sure a holistic approach was taken to preserve all possible assets. This is especially important where there is a spouse or where there is a home.  Often, we recommend preparing trusts and revising Wills for the community spouse to complete the planning. Salvatore M. Di Costanzo and the highly experienced elder care attorneys at Plan Today for Tomorrow will help guide and educate you successfully through this process.

Where there is a spouse in the community and not in a nursing home, we can use a planning technique called spousal refusal so that the spouse’s income and resources are not counted towards the institutionalized spouse’s care. With this kind of planning it is very important to work with an elder law attorney to make sure you understand the implications of this strategy and to do estate planning to make sure the planning is as effective as possible.

The best time to plan is when you are healthy and do not anticipate requiring nursing home care services for at least five (5) years, but acknowledge that at some point you may require care.

A Medicaid Trust is one of the most common advance planning techniques but in many cases no planning has been done and care is imminent.  It is important to meet with an elder law attorney to discuss the best way to preserve some of your assets.  For more information concerning Medicaid Trusts, click here.

In-Home Care and Medicaid Planning

Most people feel more comfortable at home and wish to receive all the care they need at home; however, people worry that they do not have the funds to pay for the care. After all, home health aides can cost as must as $25/hour and privately paying can quickly deplete a family’s savings leaving insufficient funds to run the household.

One option that you can use to preserve your assets and receive home health care services is to have Medicaid pay for your home health aides. The Medicaid home health care application process is very complicated and there are two components to a successful Medicaid in-home care application:

  • Financial Eligibility – determine that you are financially eligible for Medicaid and if not, what planning can be done to create eligibility. While there is no penalty for transfers, it is important to speak with an elder law attorney regarding your assets.

  • Medical Eligibility – If you are disabled and require assistance with one or more activity of daily living, you will qualify for Medicaid. What must be determined is how many hours of in-home care you will receive. We will work with you to receive the maximum number of hours you are qualified for.

Financial eligibility for Medicaid home care is just the first step in an increasingly complex process that involves many people from different places including the Department of Social Services, a Managed Long Term Care Company, a Pooled Trust Company and the Home Health Care Agency

Contact Us with your Medicaid Planning Questions

Our firm regularly does Medicaid Planning in Westchester County, Rockland County, Putnam County, Dutchess County, Orange County, New York City (Manhattan, Queens, Brooklyn, Staten Island, Bronx), Nassau County and Suffolk County.

Call us at 914-925-1010 (Rye Office) or 914-245-2440 (Yorktown Heights Office) to schedule a consultation or complete our online form.

Articles and Blog Posts

Click on the following links to read our articles and blog posts on related topics:

Medicaid Planning

Medicaid Trusts

Long-Term Care: specifically (1) Home Care; (2) Nursing Home Care



I rarely, if ever, spend valuable time reviewing businesses. I am making an exception for Maker, Fragale & Di Costanzo law firm, the elder care attorneys we retained for my parents' financial planning and medicaid applications. They were outstanding in all aspects, but especially in the respect and compassion they showed my parents, as my mother had significant health issues and limited mobility, while my father suffered from Alzheimers. In relation to our legal needs, all the services they were to provide were explained to us in easy-to-understand terms, while detailing any and all possible scenarios throughout the process. There were prompt responses to any questions or concerns we had. Any appointments were scheduled with utmost consideration of my parents. It was an emotionally difficult time for my family and I am grateful to Joanna, Melanie, Salvatore & Bill for the excellent work they did for us.
My husband and I had done a Trust a few years ago with Sal Di Costanzo for our Mom. We were so pleased that we kept going to Sal for our own taxes. Then in the beginning stages of this pandemic, we had to get a Trust for our home, a will for both of us and health care proxy. We were in the best hands because Sal did a zoom meeting and we were able to get all the signings done for everything! What we find is that we are always in the best hands with this firm! We learn a lot because they provide ongoing information, talks and newsletters on topics that need to be taken care of. We are so pleased and feel fortunate that we chose to use Sal way back for our Mom… it’s comforting to know this wonderful firm is there for us!
Debra and Jon S.

“Sal and Jen were extremely helpful as we navigated the confusing labyrinth of social services and the Medicare application process. In all of our interactions with them they were professional, responsive, thorough, and empathetic as we worked to secure care for our father. Without Sal and Jen, the process would have taken much longer, and we may not have been successful in making sure we had the resources to help make our Father's last years as comfortable as possible.”

– Eric T–

Medicaid Planning Testimonial
Sal Di Costanzo, You are the best Elder attorney. I am an only child and you helped me live through the time my Aunt and Uncle both needed nursing home care. They had no planning not even a will. You helped me get power of attorney and a living trust to be able to care for them as they deserved. Unfortunately by the time they both qualified for Medicaid after 2 years of your hard work they passed away in February, when Medicaid was being approved that May. They had a quality life due to your planning efforts, and dealing with my emotional status through it all you kept me on the the right track. It was not even a year later that I came to you with my Dad to do the right thing for him and create an irrevocable trust. We are almost 8 years out from the beginning of that irrevocable trust and Dad is still thriving at 87. I can’t thank you enough, today I called you for some advice for my mother in law again you rose to the occasion. Sal, may God bless you and your team for all the wonderful work and emotional support you have lent me over the years.
Angela O.
I obtained the DiCostanzo team, specifically Joanna Feldman and Evan Gibson after they were recommended to me by a friend who had used their elder care services. I needed help getting my husband on Community Medicaid after he became ill. The process is long, confusing and stressful. There is no way that I could have completed it on my own even without the added stress of my husband’s condition. The team is knowledgeable, patient, competent. The thing that mattered most to me was that I could trust that they totally knew what they were doing based on my friend’s original recommendation. And, when all was said and done, everything fell into place with the Medicaid insurance without a hitch. I am so pleased and grateful for their help and expertise. They have my highest recommendation.
Linda W.