Long-Term Care Medicaid Planning
Americans are living longer than ever, and with longevity comes new challenges—especially the soaring cost of long-term care. Nursing home care in New York can cost over $150,000 per year, quickly depleting even the most carefully saved nest egg. At Angiuli & Gentile, LLP, we help families plan legally and financially for this critical phase of life.
Our elder law attorneys bring a deep understanding of Medicaid law, asset protection tools, and crisis intervention strategies to help clients protect what matters most—their home, their savings, their independence, and their family’s well-being.
This area of law is not just about money—it’s about dignity, security, and peace of mind. With offices in Staten Island, our firm has served the New York community for over 30 years with compassion and precision.
Elder Law Defined: What It Covers
Elder law is a broad field that intersects estate planning, healthcare law, Medicaid eligibility, and guardianship. It is tailored to the needs of older adults and their families, helping them prepare for the legal, financial, and medical realities of aging.
At Angiuli & Gentile, LLP, our elder law services are focused on:
- Medicaid and Long-Term Care Planning
- Asset and Income Protection Strategies
- Guardianship and Incapacity Representation
- Powers of Attorney and Advance Directives
- Elder Abuse Prevention and Intervention
- Estate and Probate Planning Coordination
We take a holistic approach—integrating estate, financial, and healthcare concerns—to help clients live with dignity and protect their life’s work.
Understanding the Cost of Long-Term Care
Before diving into legal strategies, it’s critical to understand just how expensive long-term care has become.
- Average cost of nursing home care (private room in NYC): $420–$480/day
- Annual average cost: Over $150,000
- Medicare coverage: Typically only covers up to 100 days (and only under specific conditions)
Without Medicaid, most families cannot afford long-term care for more than a few months. But Medicaid is not automatically available—you must qualify based on strict income and asset limits.
Our role is to help you qualify without losing your home or savings.
Medicaid Eligibility: Breaking Down the Rules
To qualify for Medicaid long-term care coverage in New York, an applicant must:
- Have limited income and assets under Medicaid’s thresholds
- Pass the look-back review, which examines transfers of assets made within five years before applying
- Comply with income cap rules in certain regions and facilities
- Avoid improper gifting or disqualifying transfers
Our attorneys assess your eligibility in detail, develop strategies to fix potential problems, and ensure full legal compliance.
We handle:
- Medicaid spend-downs
- Income trusts (e.g., pooled income trusts in NY)
- Corrective transfers with spousal exemptions
- Crisis applications with penalty mitigation
- Appeals in cases of denial
The Medicaid Look-Back Period Explained
Medicaid uses a five-year “look-back” period to evaluate financial transactions before your application. Improper transfers (such as gifting money to children) during this period can lead to penalty periods, delaying eligibility for months or even years.
What does this mean?
If you transferred $100,000 to a family member within five years of needing care, Medicaid could impose a penalty (based on a formula) that makes you ineligible for coverage for a period of time—even if you no longer have that money.
Our attorneys help:
- Reverse improper transfers if possible
- Identify exempt transfers (e.g., to a spouse or disabled child)
- Establish Medicaid Asset Protection Trusts (MAPTs) before penalties are triggered
- Create contingency plans for coverage during penalty periods
Legal Tools to Protect Your Assets
At Angiuli & Gentile, LLP, we use sophisticated tools to help you legally protect your assets while qualifying for Medicaid. These include:
Irrevocable Medicaid Trusts
Protect your home and savings while maintaining Medicaid eligibility. These trusts must be properly structured and funded at least five years before care is needed to avoid penalties.
Durable Powers of Attorney (POA)
A powerful document that allows a trusted individual to manage your finances, sign Medicaid applications, and restructure assets if you become incapacitated.
Health Care Proxy and Living Will
Ensures your medical wishes are followed and assigns a trusted decision-maker to speak for you if you cannot.
Lady Bird Deeds / Life Estate Deeds
Tools that allow the transfer of property ownership outside of probate while maintaining Medicaid exemptions.
Spousal Refusal
In New York, a spouse can legally refuse to contribute to the cost of care for their partner—shifting the financial burden to Medicaid while preserving marital assets.
Each client’s plan is tailored based on goals, health status, financial situation, and family dynamics.
Crisis Planning vs. Pre-Crisis Planning: What You Need to Know
Pre-Crisis Planning
Pre-Crisis Planning allows you to maximize your options. If done at least five years before care is needed, strategies like irrevocable trusts can protect 100% of your home and savings.
Benefits include:
- Complete Medicaid compliance
- No penalty periods
- More flexibility and control
- Reduced emotional stress for family members
Crisis Planning
Crisis Planning, however, is still possible when care is needed now or within months.
We help families:
- Immediately assess assets and income
- Implement emergency legal tools
- File expedited Medicaid applications
- Negotiate with nursing homes or assisted living facilities
- Explore exemptions and partial asset protection strategies
Even in crisis, we can often save 40–60% or more of a client’s assets with proper legal intervention.
Guardianship & Incapacity: When Decisions Can’t Wait
When a loved one has lost the capacity to make decisions—and no power of attorney exists—legal guardianship may be required.
Our attorneys assist with:
- Filing guardianship petitions in New York Supreme or Surrogate’s Court
- Representing petitioners (usually family members or caregivers)
- Managing contested guardianship cases involving elder abuse or financial exploitation
- Handling ongoing guardianship reporting and compliance requirements
We provide sensitive and effective guidance throughout these emotional proceedings, prioritizing the dignity and protection of your loved one.
Protecting the Family Home from Medicaid Estate Recovery
After a Medicaid recipient dies, New York State can attempt to recover costs from their estate, including the value of the home. Without a protection plan in place, families may be forced to sell the house to satisfy these claims.
Strategies to prevent estate recovery include:
- Transferring the home into a Medicaid Asset Protection Trust
- Executing a life estate deed
- Using spousal exemptions
- Leveraging a caregiver child exemption, when applicable
We structure your plan to ensure that your home passes safely to your heirs, not to the government.
Our Process: What to Expect
We begin every client relationship with a confidential consultation, where we:
- Discuss your family situation, health status, and goals
- Review your income, assets, and legal documents
- Identify immediate issues or opportunities
- Design a tailored legal strategy
- Assist with implementation, applications, and ongoing compliance
Our firm’s comprehensive elder law services are designed to support you at every stage—from early planning to crisis management and beyond.
Why Choose Angiuli & Gentile, LLP
For more than three decades, Angiuli & Gentile, LLP has been a trusted name in elder law, estate planning, and Medicaid strategy in Staten Island. We combine legal experience with personal compassion, guiding families through some of the most stressful moments of life.
What makes our firm the right choice for your elder law needs?
Tailored Legal Planning
Every family is different, and your plan should reflect that. We never take a one-size-fits-all approach.
Local Focus
We know New York Medicaid rules and work closely with local care providers, nursing homes, and agencies.
Clear Communication
We take the time to explain each step of the process in simple, understandable terms.
Responsive and Accessible
Our attorneys and support staff are here when you need us, not just during business hours.
Full-Service Capabilities
Beyond elder law, we offer estate planning, real estate, litigation, and family law services—all under one roof.
We’re not just here to fill out paperwork. We’re here to help you protect everything you’ve built and provide for the people you love.
Frequently Asked Questions
How do I protect my parent’s savings from nursing home costs?
We use a combination of trusts, spend-down strategies, and Medicaid planning tools to protect assets while still qualifying for benefits.
Can Medicaid take the house after my loved one passes away?
Yes, through estate recovery—but only if no protections are in place. With proper legal planning, we can often avoid Medicaid liens on the home.
When should I start long-term care planning?
The earlier, the better—ideally at least five years before care is needed. But if care is needed immediately, we can still implement emergency planning solutions.
What documents do I need to begin Medicaid planning?
You’ll need financial records, legal documents, property deeds, and medical information. We’ll give you a clear checklist during your consultation.
Is it too late to protect assets if my parent is already in a nursing home?
Not necessarily. There may still be crisis planning options available to preserve some assets and secure Medicaid coverage.
We take the time to answer every question thoroughly and in plain language. There are no wrong questions—just important answers.
Contact Angiuli & Gentile, LLP Today
Don’t wait for a crisis to start planning. The earlier you act, the more options you’ll have to protect your family’s assets, care preferences, and financial future.
Call us at 347-941-2526 to schedule your private elder law consultation. You can also contact us through our secure online form and a member of our legal team will respond promptly.
