Planning for long-term care can feel overwhelming. You may be thinking about nursing home costs, home care, your family home, or how your spouse will manage if you need care.
You may also hear the terms Medicare and Medicaid used together. They are not the same program. Understanding the difference is an important first step.
This is Part 1 of our three-part series. We will explain how Medicare and Medicaid work, why New York and Florida rules differ, and what families can do before a health crisis creates pressure.
Medicare and Medicaid serve different purposes
Medicare is health insurance
Medicare generally provides health insurance for adults age 65 and older and for certain people with disabilities. It is a federal program. Its basic rules apply across the country.
Medicare may cover:
- Hospital care
- Doctor visits
- Outpatient services
- Prescription drugs through Part D
- Some home health care
- Short-term skilled nursing facility care after a qualifying hospital stay
Medicare does not generally pay for ongoing custodial long-term care. Custodial care includes help with daily activities such as:
- Bathing
- Dressing
- Eating
- Using the bathroom
- Moving safely
- Supervision related to a chronic condition
Medicare may cover short-term skilled care when you meet the program’s requirements. For example, it may cover limited skilled nursing facility care after a qualifying inpatient hospital stay. You can review current coverage rules through Medicare’s official skilled nursing facility guidance.
Medicaid is needs-based
Medicaid is a joint federal and state program. It may help pay for medical services and long-term care when you meet applicable income, resource, medical, and other eligibility requirements.
Medicaid may help cover:
- Nursing home care
- Certain home and community-based services
- Personal care services
- Medicare premiums and cost-sharing for some eligible individuals
- Other services that Medicare does not cover
Medicaid rules are not identical in every state. New York and Florida each have their own application procedures, financial rules, program structures, and long-term care policies.
The Medicaid.gov overview of long-term services and supports provides useful general information. It does not replace state-specific guidance or legal advice.
Why long-term care planning should begin early
A crisis can force your family to make decisions quickly. There may be little time to review documents, gather financial records, understand eligibility rules, or coordinate care between states.
Planning early gives you more time to:
- Identify the type of care you may want
- Review your income and resources
- Understand how your home may be treated
- Coordinate your estate plan with long-term care planning
- Discuss responsibilities with your spouse and children
- Prepare powers of attorney and health care documents
- Consider lawful planning options before an application becomes necessary
- Avoid rushed transfers or incomplete applications
Early planning does not guarantee Medicaid eligibility. It also does not mean every asset can be protected from care costs. Instead, it gives you an opportunity to understand your choices under the law.
At Santopolo Law, PLLC, we approach planning as part of your broader Life & Legacy Planning®. That means we look at your family, your assets, your care preferences, and your goals together.
Spend-down rules do not mean giving everything away
Many families hear the phrase “spend down” and assume they must give away their savings. That can be a dangerous misunderstanding.
A Medicaid spend-down generally involves reducing countable resources to the applicable eligibility level through lawful, documented transactions. Depending on the circumstances, this may involve paying legitimate expenses or using resources for permitted purposes.
It does not mean you should:
- Give money to children without legal guidance
- Add a child to your deed or bank account as a quick fix
- Sell property below its fair market value
- Create or fund a trust without understanding its effect
- Transfer assets based only on advice from a friend or online source
A transfer for less than fair market value may be treated as an uncompensated transfer. That transfer may result in a penalty period during which Medicaid will not pay for certain long-term care services.
Planning is different from improper asset transfers
Lawful Medicaid planning considers the rules before action is taken. It may involve reviewing ownership, trusts, spousal protections, exempt resources, and care options.
Improper transfers attempt to hide or give away assets to qualify. They may create penalties, cause application problems, or leave your family without resources to pay for care.
The difference depends on the facts, timing, documentation, and applicable law. A general article cannot tell you whether a particular transfer is permitted.
Look-back periods differ by state and benefit type
A Medicaid look-back period is a period during which the agency reviews financial transactions. The purpose is to identify transfers made for less than fair market value.
New York
New York’s rules depend on the type of Medicaid benefit involved.
For nursing home Medicaid, New York generally applies a 60-month look-back period for transfers of assets. The agency may review transactions involving the applicant and, in many situations, the applicant’s spouse.
New York has also considered changes affecting community-based long-term care, including home care and managed long-term care. The rules and implementation status can change. Families should review current guidance with the New York State Department of Health and the appropriate local agency before taking action.
The state also provides information about long-term care Medicaid programs and Managed Long Term Care.
Florida
Florida generally applies a 60-month look-back period for Medicaid long-term care programs, including nursing facility care and certain home and community-based services.
Florida may review financial records for transfers made during the look-back period. A transfer for less than fair market value may result in a period of ineligibility based on the value of the uncompensated transfer and the applicable penalty divisor.
You can review Florida’s Medicaid policy materials on transfer of assets. Florida’s Agency for Health Care Administration also provides information about Florida Medicaid programs.
Because state rules change, do not rely on an old five-year calculation or a general online chart. Current eligibility rules and application requirements should be confirmed before you transfer property or apply for benefits.
Married couples need careful planning
Medicaid rules can treat married couples differently from single applicants. The spouse who remains in the community may be called the community spouse. Certain protections may allow that spouse to retain income and resources within limits established by law.
These protections can involve:
- Community spouse resource allowances
- Income allocation rules
- Treatment of jointly owned property
- Spousal transfers
- Nursing home costs
- Household expenses
- Estate recovery concerns
The rules are technical. The allowable amounts change. New York and Florida do not use identical procedures.
A transfer between spouses may avoid a transfer penalty in some circumstances, but that does not automatically mean the couple qualifies for Medicaid. The couple’s overall financial picture, care setting, income, resources, and other factors still matter.
Home ownership creates additional questions
Your home may be your most valuable asset and your most important source of security. Medicaid may treat a primary residence differently from other property, but the result depends on the circumstances.
Questions may include:
- Is the property your principal residence?
- Does your spouse or another protected family member live there?
- Do you intend to return home?
- How much equity does the property have?
- Is there a second home?
- Is the property located in New York or Florida?
- Could estate recovery affect the property later?
- Is the property titled individually, jointly, or through a trust?
A home in Buffalo or elsewhere in Erie County may be treated differently from a Florida Gulf Coast property in Clearwater, St. Petersburg, Dunedin, Largo, Safety Harbor, or Bradenton. A second property may also raise separate eligibility and tax questions.
Do not retitle your home or add a family member to the deed without understanding the possible Medicaid, tax, creditor, probate, and family consequences.
Snowbirds should plan for both states
Medicare is a federal program, but your specific coverage may still depend on whether you have Original Medicare, a Medicare Advantage plan, a Medigap policy, or a prescription drug plan. Medicare Advantage plans may use provider networks and other geographic restrictions. Review your plan before receiving care in another state.
Medicaid is different. It is state-administered and generally connected to state residency. A New York Medicaid program is not automatically portable for long-term care in Florida. Likewise, Florida Medicaid does not automatically cover long-term care in New York.
Snowbirds should consider:
- Which state is your legal residence
- Where you expect to receive long-term care
- Whether you own homes in both states
- How each state treats your property
- Which state’s Medicaid application process may apply
- Whether your powers of attorney and health care documents work where you are receiving care
- Whether your estate plan coordinates property in both states
Our Snowbird and Dual-Resident Estate Planning page explains why a coordinated plan matters for families connected to New York and Florida.
Practical steps you can take now
You can begin preparing without making any immediate transfer or application.
1. Gather your records
Collect:
- Bank and investment statements
- Retirement account information
- Deeds and mortgage records
- Insurance policies
- Tax returns
- Existing trusts and estate planning documents
- Pension and Social Security information
- Records of gifts or property transfers
2. Identify your care preferences
Think about whether you would prefer:
- Care at home
- Assisted living
- Skilled nursing facility care
- Care near family
- Care in New York or Florida
Your preferences may affect the planning discussion.
3. Review your incapacity documents
A durable power of attorney and health care directive can help identify who may act for you if you cannot make or communicate decisions. Visit our incapacity planning page to learn more.
4. Review your existing plan
An older plan may not reflect:
- Your current state of residence
- A second home
- Changes in your marriage or family
- New accounts
- New beneficiaries
- Current Medicaid rules
- Your preferred agents and caregivers
5. Get advice before changing ownership
Transfers, gifts, trusts, and changes to deeds require careful review. Planning before a crisis may provide more options than planning after you enter a facility or need immediate services.
Part 2 and Part 3 of this series
In Part 2, we will explain Medicare appeals, including what you can do when Medicare or a Medicare plan denies coverage, payment, services, or medication.
In Part 3, we will discuss Medicare grievances. A grievance is generally a complaint about care, service, access, delays, or plan administration. It is different from an appeal, which challenges a coverage or payment decision.
Start with a clear conversation
Long-term care planning involves more than choosing a document. It requires a review of your family, property, finances, care preferences, and connection to New York or Florida.
We help families in Erie County, New York, Florida’s Gulf Coast corridor, and snowbirds with property or family ties in both states understand their planning options.
Learn more about Elder Law and Medicaid Planning or contact Santopolo Law, PLLC to schedule a conversation.
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Legal information disclaimer: This article provides general information only. It is not legal, tax, financial, or benefits advice. Medicaid and Medicare laws, regulations, policies, eligibility standards, and agency procedures vary between New York and Florida and may change over time. Eligibility depends on current law and the applicant’s specific circumstances. Reading this article does not create an attorney-client relationship with Santopolo Law, PLLC. Do not take action involving transfers, trusts, property, or benefits applications without obtaining advice based on your circumstances.
Santopolo Law, PLLC
Bona Fide Office: 300 International Drive, Suite 100, Buffalo, NY 14221
Licensed in New York and Florida. Florida consultations may be available remotely.