Community Medicaid and Home Care Attorneys
Community Medicaid is Medicaid that pays for long-term care where you live instead of in a nursing home. It can cover a home health aide, hands-on personal care, adult day programs, and, in some states, services in an assisted living setting. The care is what a facility would provide; you simply stay home.
Our attorneys handle home-care Medicaid from the first eligibility analysis through approval and the years of recertifications that follow. Families usually come to us after a hospital stay, a fall, or a dementia diagnosis, when the hours of help outgrow what the family can cover and Medicare has stopped paying. Because the three states we practice in run very different programs, the plan we build depends on where you live.
Key Takeaways:
- Community Medicaid pays for long-term care at home, and eligibility turns on two separate tests: a functional assessment of your need for hands-on help, and a financial review of your income and resources.
- The programs are not the same across state lines. Program names, assisted living coverage, transfer review, and excess-income tools all differ, so a strategy that works across the river may not work where you live.
- We work in three stages: planning before you file, managing the application through approval, and defending the benefit afterward when hours or eligibility are cut.
How We Help
Three stages, and most families need all three:
- Before filing. We analyze eligibility, build the spend-down strategy, convert countable assets into exempt ones where the rules allow, set the timing for a Medicaid asset protection trust, arrange excess-income handling, and address spousal planning for the spouse staying home.
- The application. We prepare and file it, assemble the financial record, write the transfer explanations, coordinate with the clinical assessment, and carry the case through managed care or program enrollment.
- After approval. We handle recertifications, changes in care level, moves from home care to assisted living or a nursing home, and appeals when authorized hours or eligibility are cut.
The detail on each stage is below the state comparison, which explains why the same plan does not travel between states. This is Medicaid planning aimed at care at home rather than a facility admission.
Community Medicaid State by State
New York
New York calls home-based coverage community Medicaid, delivered mostly through Managed Long Term Care plans, which the Department of Health describes as serving people who are chronically ill or disabled and wish to stay in their homes. Covered services include home care, adult day health care, nursing and therapies at home, private duty nursing, and consumer directed personal assistance. Under CDPAP, a member may hire their own personal assistant, including a family member, though not a spouse; a spouse remaining at home may instead want to consider spousal refusal planning. The Assisted Living Program serves people medically eligible for nursing home placement in a lower-cost setting, with services approved in advance by the local district; what a resident pays out of pocket varies, so confirm with us. Surplus income can go to a pooled trust run by a nonprofit. Initial community health assessments run through the New York Independent Assessor Program.
The look-back is the headline. A 30-month look-back for community-based long-term care was enacted in the April 2020 State budget but requires federal approval. New York submitted its waiver amendment to the Centers for Medicare & Medicaid Services on March 25, 2021, and the Department’s page for it still shows only that submission and a federal completeness letter dated April 7, 2021. As of September 20, 2026, the look-back has not been implemented, and home care applications are reviewed without a transfer penalty. The law was never repealed, only left unimplemented, so this is a rule that can be activated. Our New York Medicaid planning page has more.
New Jersey
New Jersey delivers long-term care through Managed Long Term Services and Supports, part of NJ FamilyCare, coordinated by managed care organizations. The state describes MLTSS as comprehensive care in settings including assisted living facilities, group homes, nursing homes, or your own home, so people who need a nursing home level of care can live where they choose. Listed benefits include care management, home and vehicle modifications, home-delivered meals, respite care, and emergency response systems. Clinically, an adult must require hands-on assistance with three or more activities of daily living, or cognitive deficits requiring supervision with three or more; managed care organizations assess and the Division of Aging Services decides. What a resident contributes toward assisted living room and board, as opposed to services, varies; confirm with our attorneys.
Financially, a County Social Service Agency caseworker reviews five years of income and resources from the first MLTSS application, and that review applies to home-based MLTSS, not only nursing home care. Excess income goes into a qualified income trust, available whether the applicant lives in a nursing facility, an assisted living facility, or their own home; each trust must be agency-approved and reviewed annually. State guidance tells married applicants that if a spouse is not applying, some marital assets will be set aside for that spouse.
Connecticut
Connecticut runs the Connecticut Home Care Program for Elders through contracted access agencies rather than managed care plans. By statute, the Commissioner of Social Services administers it to prevent the institutionalization of elderly persons, in two parts: a Medicaid-funded portion for people who receive or would be eligible for medical assistance, and a state-funded portion for people 65 and older who are not Medicaid eligible, are at risk of inappropriate institutionalization, and whose income and assets fall within statutory limits tied to federal spousal protection figures. Services named in the statute include homemaker and companion services, meals on wheels, adult day care, transportation, mental health counseling, care management, and minor home modifications.
Assisted living coverage is narrower than in the neighboring states: the statute authorizes assisted living services in state-funded congregate housing and in assisted living pilot or demonstration projects, not assisted living generally. Participants in the state-funded portion contribute three per cent of their cost of care, and those above 200 per cent of the federal poverty level also contribute applied income. The Department states that help with home and community based services requires a five-year income and asset review for someone who has not been a medical assistance recipient. Excess income is handled through a spend-down of incurred medical expenses.
| New York | New Jersey | Connecticut | |
|---|---|---|---|
| Program | Community Medicaid | MLTSS (NJ FamilyCare) | CT Home Care Program for Elders |
| Home care covered | Yes | Yes | Yes |
| Assisted living covered | Yes, via the Assisted Living Program | Yes, as an MLTSS setting | Limited to certain state-funded settings |
| Look-back at home | 30-month law enacted 2020, not implemented as of 9/20/2026 | Yes, five years | Yes, five years |
| Excess income | Pooled income trust | Qualified income trust | Spend-down and applied income |
| Delivery | MLTC plans | Managed care organizations | Access agencies |
What Our Service Includes
1. Eligibility analysis and planning before filing
We start with a written analysis: what the resources and income actually are, which of them are exempt, what was transferred in the relevant window, and what the gap is between today and eligibility. From there the plan may include a spend-down on permitted items, conversion of countable assets into exempt ones, and correct handling of retirement accounts.
Trust timing is state-driven. A Medicaid asset protection trust holds your home and investments outside your countable resources; you keep the income and, when drafted for it, the right to live in the home, but you cannot take principal back. In New York, with no community look-back in operation today, a newly funded trust can support a home care application far sooner than a nursing home application, an advantage tied to a rule that could be activated. In New Jersey and Connecticut, the five-year review reaches home and community based care, so the trust has to be funded well ahead of the need. We also set up excess-income handling where the state allows it, and plan for the spouse staying home, since federal spousal protections were written for the institutional case and states apply them to community programs unevenly. For care needed next month, we turn to crisis tools instead: exempt transfers of the home, personal care agreements, and, in New York, the gifting and promissory note strategy, also known as half-a-loaf planning.
2. Preparing and managing the application
We prepare and file the application, then run it. That means assembling account statements for the full review period, deeds, insurance and retirement records, and writing the explanation for every deposit and transfer the caseworker will question, because an undocumented transfer is treated as a gift. We respond to requests for additional documents, track processing, and press when a case stalls.
We also prepare you for the clinical assessment so the help you actually need is described accurately rather than on a good day, and we coordinate the financial track with the clinical one so enrollment in a plan or program is not delayed by a gap between them.
3. After approval
Approval is the start of a long relationship with the agency. We handle annual recertifications, report changes in income, resources, and living arrangements, and revisit authorized hours when the level of care changes. When a move becomes necessary, from home to assisted living or to a nursing home, we handle the change in program and the different financial rules that follow it, including the transfer review that applies to facility care.
We also appeal. If the agency denies eligibility, reduces authorized hours, asserts a transfer penalty, or terminates coverage, we ask for the record, identify the ground it rests on, and take the case through the state’s hearing process. Deadlines for these appeals are short and vary by state and notice type, so send us the notice the day it arrives. Ongoing maintenance, including annual trust reviews, is available through our Client Care Program.
Common Mistakes and When Community Medicaid Is Not the Answer
- Applying one state’s look-back assumption in another, and either gifting where transfers are reviewed or abandoning planning where they are not
- Gifting to children informally and being unable to document it, or paying a family caregiver in cash with no written agreement
- Understating the help needed at the clinical assessment, or funding an income trust without agency approval
Community Medicaid is not right for everyone. If the care needed already exceeds what can safely be delivered at home, planning belongs on nursing home eligibility instead. If the real problem is capacity rather than money, fix the power of attorney and health care directives first, which our elder law practice handles.
Schedule a Community Medicaid Consultation
The time to ask about home care Medicaid is when the hours of help start climbing, not after savings are gone. Bring a list of accounts, the deed to the home, any existing trust or power of attorney, and a description of a typical day. Our attorneys practice in New York, New Jersey, and Connecticut.
This page is provided for general informational purposes only and does not constitute legal advice. Laws differ by state and change over time. For advice about your situation, consult a qualified attorney.
Frequently Asked Questions
What is community Medicaid?
Community Medicaid is Medicaid coverage for long-term care delivered where you live rather than in a nursing home. It can pay for a home health aide, hands-on personal care, adult day programs, and, in some states, services in an assisted living setting. States use different names for the program and cover different services.
How is community Medicaid different from nursing home Medicaid?
Both are Medicaid, but they are separate eligibility determinations with different rules. The level-of-care standard, the way transfers are reviewed, and the treatment of a spouse’s income and resources can all differ between the home setting and the institutional setting. A plan built for one setting does not automatically work for the other.
Does Medicare pay for home care?
Medicare pays for short, skilled episodes of home health care, such as nursing or therapy after a hospital stay. It does not pay for ongoing custodial help with bathing, dressing, and similar daily activities. That long-term help is what community Medicaid is designed to cover.
Can a family member be paid to provide the care?
In some states, yes. Consumer-directed programs allow the person receiving care to hire and direct a caregiver, and in some cases a family member or friend can be paid through the program. Separately, paying a relative privately generally requires a written personal care agreement, because an undocumented payment can be treated as a gift.
Is there a look-back period for home care Medicaid?
It depends on the state. Some states apply the same transfer review to home and community-based services that they apply to nursing home care, and others do not currently review transfers for community services. Because this is one of the few rules that can change with little notice, confirm the current position in your state before making any transfer.
What happens if my income is too high?
Income above the program limit does not automatically disqualify you. Depending on your state, age, and disability status, the surplus may be spent down on medical costs each month, placed in a qualified income trust, or deposited into a pooled income trust administered by a nonprofit. These arrangements usually require agency approval and must be funded correctly each month.
Will Medicaid pay for assisted living?
Sometimes. Several states cover services delivered inside an assisted living setting, though coverage of the room-and-board portion is treated differently and is often not covered. Confirm what your state’s program pays for before committing to a particular residence.
Can I qualify for home care Medicaid if I own my home?
Often yes. A primary residence is commonly exempt from countable resources, subject to equity limits and other conditions that vary by state. Owning a home raises separate questions about estate recovery and long-term protection, which is why home ownership is usually the first thing an attorney reviews.
Does a Medicaid asset protection trust help with home care?
It can, but the timing depends on your state. Where a state does not apply a transfer look-back to community services, a newly funded trust may support a home care application much sooner than it would support a nursing home application. Where the state does review transfers for home care, funding the trust starts a waiting period that must run first.
How do I start a community Medicaid application?
Two things happen in parallel: a clinical assessment establishes that you need the level of care the program covers, and a local or county agency reviews your finances. Gathering financial records early is the single most useful step, because missing documentation is the most common reason applications are delayed or denied.
