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  • How Are Retirement Accounts Treated for Medicaid Long-Term Care Eligibility in New York?

    If you or a loved one is considering applying for Medicaid to cover long-term care in New York—such as nursing home care or home care services—it’s essential to understand how retirement accounts (like IRAs and 401(k)s) are treated during the Medicaid eligibility process. These accounts can significantly impact whether you qualify, how much you may have to spend down, and what planning options are available.

    Medicaid Basics: Income and Resource Rules

    To qualify for Medicaid long-term care, applicants must meet strict income and asset limits. In 2025, an individual applying for Medicaid in New York can have $32,396 in countable assets. If they are applying for nursing home Medicaid coverage, they can only keep $50 of their monthly income. If they are applying for home care coverage, the income limit is $1,799.95 (some deductions and allowances apply, and further planning can be done to allow income above that limit to be preserved).

    Retirement Accounts: Countable or Exempt?

    Whether a retirement account is counted as a resource depends on whether the account is in “Pay Out Status.”

    Payout Status means that the Medicaid applicant is receiving Required Minimum Distributions (RMDs) from the retirement account, paid in monthly payments.

    The monthly payments are considered countable income by Medicaid.

    This rule applies to retirement accounts such as:

    • Traditional IRAs
    • 401(k)s
    • 403(b)s
    • Other qualified plans

    There are differences in the definition of “Payout Status” under IRS rules and Medicaid rules:

    • Under IRS rules, a retirement account owner doesn’t have to take RMDs until they reach a certain age (73), but under Medicaid rules, regardless of your age, you would have to take the RMDs in order for Medicaid to exempt the principal amount of the retirement account.
    • IRS only requires an annual payout, whereas Medicaid requires that the payments from the retirement account be made monthly.
    • Even though a ROTH IRA, which is funded with post-tax income, doesn’t have to be put in payout status under the IRS rules, Medicaid would require that it be in “Payout Status” to be an exempt resource for Medicaid eligibility.
    • The Department of Social Services uses its own life expectancy table, which could be shorter than the IRS table, which could result in the retirement account owner having to take a higher distribution amount under Medicaid rules to exempt the account as a Medicaid resource.

    Example:
    A 75-year-old applicant has a $200,000 IRA and takes the required annual distribution payable in monthly installments. The $200,000 principal is not counted toward the $32,396 asset limit. However, the monthly RMD amount (e.g., $1,000/month) is added to the applicant’s countable income.

    If the retirement account was not in payout status, meaning the applicant is not receiving monthly distributions as per the life expectancy table, then the entire retirement account is treated as a countable asset.

    Planning Strategies for Retirement Accounts

    Before applying for Medicaid, if the applicant has not yet been taking RMDs, or the RMDs have not been distributed in monthly payments, the applicant should begin taking the payouts or restructure to monthly payments to exempt the account principal. This should be done before the Medicaid application is filed.

    Don’t cash out and transfer the retirement account without a really good reason that would be advised by the experienced elder law attorney you are working with. Cashing out will trigger significant consequences, such as tax liability, loss of creditor protection, and loss of a source of exempt funds that could be tapped into in the event you needed more than your allowable resource limit. Therefore, you should never do that unless you have reviewed the repercussions with an elder law attorney and financial advisor, and it is still advisable for your unique situation.

    Conclusion

    Retirement accounts are not automatically qualifying or disqualifying for Medicaid—but how they’re handled can make or break eligibility. Getting the right legal advice early allows families to preserve assets and avoid costly mistakes.

    If you’re planning ahead or facing an urgent Medicaid need, consulting an experienced New York elder law attorney is the most effective way to navigate retirement account issues and implement a tailored strategy.

    Need Help?

    We assist clients across Nassau County and the greater New York area with Medicaid planning, Medicaid asset protection, and long-term care planning. Contact us today to schedule a consultation and start planning with confidence.

    Retirement Accounts and Medicaid Long Term Care Eligibility
  • What is the difference between a Durable Power of Attorney and a Non-Durable Power of Attorney?

    A Power of Attorney is a document that allows someone to give authority to an individual that they choose to manage their legal and financial affairs on their behalf. The authority can be very specific to only certain transactions, standard to include the powers outlined in the statutory form, or it can be very broad and include provisions dealing with more complex matters such as trust planning, tax planning, and long-term care asset protection.

    The key difference between a durable and non-durable power of attorney lies in what happens when the person who granted the power (the "principal") becomes incapacitated or mentally incompetent. A durable power of attorney remains in effect when the principal becomes incapacitated. A nondurable power of attorney is no longer in effect if the principal becomes incapacitated.

    When signing a power of attorney for a limited transaction, such as representing you in the sale of real estate or assisting you with managing an investment, it is possible that you only want the individual to have authority while you have capacity and can call the shots. In this case, a “non-durable” power of attorney would serve your purpose. In the event you become incapacitated, your agent will no longer have authority to act on your behalf. 

    However, if you are signing a power of attorney as part of your estate planning, to make sure that if you become incapacitated, the individual you appoint will have authority to act on your behalf, your power of attorney must be a “durable” power of attorney.

    Durable Power of Attorney:

    • Remains effective even if the principal becomes incapacitated or mentally incompetent
    • Contains specific language stating it will survive the principal's incapacity (often called a "durability clause")
    • Continues until the principal's death or until formally revoked while the principal is still competent
    • Most commonly used for estate planning and long-term care planning purposes
    • Essential for situations where someone may need ongoing financial or healthcare decision-making assistance

    Non-Durable Power of Attorney:

    • Automatically terminates if the principal becomes incapacitated or mentally incompetent
    • Only remains valid while the principal maintains mental capacity
    • Becomes void precisely when the principal would most need someone to act on their behalf
    • Useful for specific, temporary situations when the principal is traveling or temporarily unavailable
    • Not useful for long-term care planning or estate planning purposes

    Practical Implications: The durability feature is crucial for estate planning because incapacity is often when families most need someone to manage financial affairs, make healthcare decisions, or handle legal matters. Without a durable power of attorney, families may need to go through expensive and time-consuming guardianship or conservatorship court proceedings to gain authority to act for an incapacitated loved one.

    It is critical to note that even if your power of attorney is “durable,” it is still critical that your power of attorney include provisions that you may require in the future. A basic statutory power of attorney does not have provisions that would allow your agent to protect your assets or income in the event you needed Medicaid long-term care, or provisions that would allow your agent to perform tax planning to minimize estate taxes. You must be sure to consult with an elder law attorney to make sure that the necessary provisions are included to maximize the planning strategies that your agent may need to perform on your behalf in the event you become incapacitated and need long-term care.

    For these reasons, it is important to seek the assistance of an elder law attorney to prepare a durable power of attorney for you as one of the foundational documents you will need for a comprehensive estate plan.

    Contact us today at 516-466-WILL (9455) and we will be happy to help you with your estate plan.

    Durable Power of Attorney vs. Non-Durable Power of Attorney
  • If you already have a 529 education savings plan as part of your family's financial strategy, there are important estate planning considerations that often go overlooked. As families face potential long-term care needs and Medicaid planning becomes a reality, understanding how your 529 account fits into this picture is crucial. Additionally, many 529 account owners fail to address what happens to these accounts upon their death, potentially subjecting their families to unnecessary probate proceedings.

    Understanding Your 529 Plan Structure

    A 529 plan is a tax-advantaged savings account designed for future education costs. As the account owner, you maintain complete control over the funds, including investment decisions, withdrawal timing, and beneficiary designations. This control structure has significant implications for both Medicaid planning and estate administration that many families don't fully understand.

    The key distinction in 529 planning is between the account owner (you) and the beneficiary (typically your child or grandchild). This separation creates unique opportunities and considerations when planning for long-term care needs and estate administration.

    Medicaid Planning Implications

    One of the most critical considerations for 529 account owners is how these assets affect Medicaid eligibility for long-term care. The treatment of 529 accounts in Medicaid planning depends on several factors that require careful analysis.

    As the account owner, the 529 assets are generally considered your resources for Medicaid purposes, which could impact your eligibility for benefits. However, the specific treatment can vary by state, and there are potential planning strategies that may help protect these education funds while preserving Medicaid eligibility.

    For beneficiaries of 529 accounts, the assets typically don't count toward their Medicaid resource limits since they don't own or control the funds. This distinction is particularly important for families with special needs beneficiaries who may require government benefits throughout their lives. The account owner's retention of control prevents the funds from disqualifying the beneficiary from crucial benefits.

    However, distributions from 529 accounts can affect Medicaid eligibility. When funds are withdrawn and used for the beneficiary's expenses, this could potentially impact their benefit calculations. Understanding the timing and structure of distributions is essential for families navigating both education funding and benefit preservation.

    The Critical Importance of Successor Custodians

    Many 529 account owners overlook one of the most important aspects of their account setup: naming a successor custodian. This oversight can create significant problems for families after the account owner's death.

    Without a named successor custodian, your 529 account may become subject to probate proceedings when you die. This means the court will need to determine who has authority to manage the account, potentially causing delays in accessing education funds when your family needs them most. Probate proceedings also increase administrative costs and create public records of your family's financial affairs.

    Most 529 plans allow you to designate a successor custodian directly through your account documents. This person will automatically gain control of the account upon your death, allowing for seamless management and distribution of education funds. The successor custodian should be someone you trust to make decisions in your beneficiary's best interests and who understands the family's educational goals.

    When selecting a successor custodian, consider their financial sophistication, proximity to the beneficiary, and long-term stability. You may also want to name a secondary successor in case your first choice is unable to serve when needed.

    Ongoing Account Management Considerations

    If you're facing potential long-term care needs, review your 529 account strategy with qualified professionals. Depending on your state's Medicaid rules and your family situation, there may be opportunities to restructure ownership or adjust beneficiaries to better align with your overall care planning strategy.

    Consider whether changing the account beneficiary might benefit your family's overall educational goals. The ability to change beneficiaries within the same family provides flexibility that can be valuable in long-term care planning scenarios.

    Regular review of your successor custodian designation is also essential. Life changes such as divorce, death, or relationship changes may require updates to ensure the right person will manage these important education funds.

    Integration with Your Overall Estate Plan

    Your 529 accounts should be coordinated with your broader estate planning documents. Ensure your attorney understands how these accounts fit into your overall plan, particularly if you're implementing Medicaid planning strategies or special needs planning for beneficiaries.

    The flexibility of 529 accounts can be both an asset and a complication in estate planning. While the account owner's control provides valuable planning opportunities, it also requires careful coordination with other estate planning tools to avoid unintended consequences.

    Moving Forward

    If you own 529 accounts, don't let these important considerations fall through the cracks. The intersection of education funding, Medicaid planning, and estate administration requires careful attention to ensure your family's needs are met both now and in the future.

    Work with experienced estate planning professionals who understand both Medicaid rules and 529 account structures. They can help you navigate the complexities of long-term care planning while preserving your family's educational goals and ensuring proper account succession planning.

    Contact us and we will be happy to help.

    Important Estate Planning Considerations for 529 Education Savings Plan
  • On April 29, 2025, the New York State Assembly passed the Medical Aid in Dying Act by a vote of 81-67 after nearly five hours of emotional debate. This legislation allows mentally competent, terminally ill adults with six months or less to live to obtain a prescription for lethal medication. If enacted, New York would become the 11th state to legalize medically assisted death, joining states that already have similar programs.

    The bill includes safeguards such as evaluations by two doctors to confirm the patient's capacity to choose and a formal written request signed by two unrelated witnesses. Despite its progress, the bill faces uncertain prospects in the Senate, and Governor Kathy Hochul has not yet taken a public stance on the issue.

    As with any deeply personal and ethically complex legislation, the Medical Aid in Dying Act has sparked a wide range of reactions. Supporters emphasize autonomy and compassion, while opponents raise concerns about potential abuse and moral implications. Below are some of the key arguments on both sides to provide a fuller understanding of the law’s potential impact.


    Pros of the Medical Aid in Dying Act

    1. Respecting Patient Autonomy

    The act empowers terminally ill individuals to make decisions about their own end-of-life care, allowing them to choose a peaceful and dignified death.

    2. Providing Relief from Suffering

    For patients experiencing unbearable pain and suffering, this law offers an option to end their lives on their own terms, potentially alleviating prolonged agony. ​

    3. Aligning with Public Opinion

    A recent poll found that over 70% of New Yorkers support the Medical Aid in Dying Act, indicating strong public backing for the legislation. ​City & State New York

    4. Safeguards Against Abuse

    The bill includes multiple safeguards, such as requiring two physicians to confirm the patient's diagnosis and mental capacity, and a mandatory mental health evaluation if necessary. ​


    Cons of the Medical Aid in Dying Act

    1. Potential for Coercion

    Opponents argue that the law could pressure vulnerable individuals, particularly those with disabilities, into choosing assisted death due to societal or familial pressures. ​

    2. Ethical Concerns

    Some religious and ethical groups contend that the act undermines the sanctity of life and could lead to a slippery slope, potentially expanding to non-terminal conditions.

    3. Impact on Medical Professionals

    Healthcare providers who oppose the practice on moral or religious grounds may face dilemmas, despite provisions for immunity from liability for those who refuse to participate. ​

    4. Implementation Challenges

    The law's success depends on effective implementation, including ensuring that all safeguards are rigorously followed, which could pose challenges in practice.​


    The passage of the Medical Aid in Dying Act in the New York State Assembly marks a significant step in the ongoing debate over end-of-life choices. While the act offers a compassionate option for terminally ill individuals seeking control over their final days, it also raises important ethical, moral, and practical considerations. As the legislation moves forward, it will be crucial to balance patient autonomy with robust safeguards to ensure that the law is implemented responsibly and equitably.

    At its core, this legislation is about how we honor the final chapter of life—balancing medical reality with personal dignity. Whether one supports or opposes the Medical Aid in Dying Act, the conversation it has sparked invites all of us to think more deeply about compassion, choice, and how we care for one another at the most vulnerable moments. These are not easy questions, but they are profoundly important ones.

    End-of-Life Choice in New York: A Compassionate Step or a Risky Precedent?