Practice area
Medicaid planning for New York families
Medicaid is what actually pays for most long-term care in New York. Qualifying for it without needlessly spending down a lifetime of savings is a planning problem, and it is one that rewards getting advice early.
Levy Law & Mediation Firm, P.C. advises New York clients who are medically eligible for Medicaid and need to become financially eligible for it. Suzanne Levy handles both sides of that work: planning in advance so assets are positioned correctly long before care is needed, and crisis planning when a parent has already entered a nursing home or been assessed for home care. The firm also represents applicants and recipients whose approved home-care hours have been reduced or denied, through the internal plan appeal and then a fair hearing before the State.
When families come to us about this
You are planning years ahead
Nobody has been diagnosed with anything yet, but you can see where things are heading and you would rather make decisions calmly than under pressure. This is the best position to be in, because the widest range of planning options is still open.
Care is needed now
A parent has had a fall, a stroke, or a dementia diagnosis, and suddenly the family is being asked how care will be paid for. Crisis planning is narrower than advance planning but it is rarely as hopeless as families assume.
Approved care hours were cut
A Managed Long Term Care plan reassessed someone and reduced their home-care hours, or denied them outright. There is a defined appeal path, and it is worth using.
A married couple with one spouse needing care
Where one spouse needs care and the other does not, planning has to account for both people; the spouse who remains at home still has to live on something.
How the process works
Medicaid planning is not a single filing. It is a sequence, and where you start depends on how much time you have.
- Understand the actual situationWe look at the care that is needed or anticipated, and separately at what the household owns and receives as income. Which type of Medicaid is in play (Community for care at home, or Institutional for nursing home care) changes the analysis considerably.
- Identify what is and is not countedNot every asset is treated the same way when eligibility is determined. A meaningful part of this work is establishing what actually counts as an available resource and what does not, before anyone starts liquidating anything.
- Build the planDepending on the timeline, this may involve a Medicaid Asset Protection Trust, transfers, restructuring how assets are held, or a spend-down strategy. Tax consequences are considered here, not afterwards, because repositioning an asset can trigger capital gains that a family did not anticipate.
- Prepare and file the applicationMedicaid applications are documentation-heavy and are frequently delayed or denied over records rather than over substance. The firm assembles the financial history the agency will ask for and submits the application.
- Appeal if the answer is wrongIf an application is denied, or approved hours are later reduced, the first appeal typically goes to the Managed Long Term Care plan itself. If the plan affirms its own decision, the next step is a fair hearing request to the New York State Office of Temporary and Disability Assistance, heard by an Administrative Law Judge.
What the appeal process actually looks like
The firm's existing practice includes a specific and often misunderstood area: what to do when a Managed Long Term Care plan reduces someone's approved home health hours after an annual reassessment.
- The first level of appeal goes to the Managed Long Term Care plan that provides the home-care services.
- There is a structural problem with that first level: the plan receives the same reimbursement whether it authorises a few hours of care or many, which does not encourage generous reassessment.
- If the plan affirms its original decision, a second appeal is available through a fair hearing request submitted to the New York State Office of Temporary and Disability Assistance using the form supplied with the notice of adverse decision.
- That request has to be submitted on time. Deadlines in this process are short and are enforced.
- A case number and hearing date are issued, and an Administrative Law Judge is assigned.
- The applicant can submit supporting documentation, which should include medical evidence and the legal basis for reinstating the hours.
- Witnesses may be called. Testimony from the applicant's treating physician tends to carry the most weight.
- The firm can be retained to prepare and submit that documentation and to appear at the hearing on the applicant's behalf.
Where we handle these matters
The firm advises Medicaid clients from offices in Great Neck and in the Woolworth Building in Manhattan, and works with families in Nassau, New York, Queens, Kings, Westchester and Suffolk Counties. Fair hearings are conducted administratively rather than in a courthouse, and are frequently held remotely.
Medicaid Planning: common questions
More questions are answered on the firm's FAQ page.
What is the difference between Community Medicaid and Institutional Medicaid?
Community Medicaid pays for care delivered where someone lives, most often home health aide hours. Institutional Medicaid pays for nursing home care. They are assessed differently and the eligibility rules are not the same, which is why the first question in any Medicaid conversation is what kind of care is actually needed.
Is it too late to plan if my parent is already in a nursing home?
Usually not, though the options are narrower than they would have been earlier. Crisis planning is a recognised part of this practice. What is genuinely unhelpful is spending down assets on the assumption that nothing can be done, before anyone has looked at the situation properly.
Do we have to spend everything before Medicaid will pay?
No, and this is the most common misconception families arrive with. Eligibility depends on what counts as an available resource, and not everything does. The purpose of planning is to reach eligibility without giving up more than the rules actually require.
Is Medicaid planning ethical?
Yes. Planning within the rules that the legislature wrote is a responsible way to preserve what a family has earned, in the same way that claiming the deductions the tax code provides is a responsible approach to income tax. The firm plans within the rules, not around them.
My mother's home care hours were just cut. How long do I have to appeal?
Act immediately. The notice of adverse decision you received states the deadline, and those deadlines are short and strictly applied. Missing one can mean losing the ability to challenge the reduction at all, so the notice should be reviewed the day it arrives.
Want to understand your Medicaid options before a crisis forces the decision?
Most families come to us with a decision that already feels overdue. A first conversation is about understanding where you actually stand and what your options are.