Currently I am living in Assisted Living (in New York). I am going to be applying for Medicaid at the beginning of next year (currently I am a private pay). What is the difference between Medicaid and Community Medicaid? Also, I was told that for Community Medicaid they only,look at 2 months of resources where as with Medicaid they go as far back as 5 years
But what has happened over the years Is that the states have diverted the traditional funding of NH Medicaid to other broader community programs - like AL & PACE & Community based services or In Home Health Services (IHHs). All the diversion funding is done by waiver programs. Waivers each can have their own criteria for eligibility which is set uniquely by each state but within an overall federal guideline. Each state administers its Medicaid program but the funds are jointly paid by both the feds & the states. So some states allow for a AL waiver but most states do not. A few states have very organized IHHS waiver programs (like CA) but most do not. Waivers since they are diversionary are not guaranteed so a program could find itself defunded which causes uncertainty for vendors so many will not participate in Medicaid waiver program or do so in very limited way. Medicare is totally a federal program so you can use your Medicare card in NYS and also at an ER in FL when your on vacation. It's really important that you understand how the M&M's are different but can work together. This site has several articles on this subject.
So your state - NY - does AL waivers & your AL takes the waiver for payment. You are fortunate as most states do no AL diversion at all. What seems to be the play book for AL is that after a certain period of private pay by a resident (maybe 2 years), if they run out of $ then the AL will take them as a medicaid community waiver resident. You should clearly speak with billing /business office & social worker as to the timing on when you run out of funds and dovetailing your waiver placement. You don't want a " gap " month or two that you don't have the $$ to pay in full till Medicaid pays if you can help it.
About the 5 yr vs 2 mos, what this likely is that if a Medicaid applicant has been private pay at a facility for a period of time their $ has been going to pay so a full 5 year look back not needed. When I moved my mom from her IL of over 3 years to her first NH (she bypassed the AL stage), the NH admissions only wanted to see her last 6 mos of finances to determine if they would take her "Medicaid Pending". But mom still had to submit another 3 years of financial info to accompany the application to the state. 3 years not 5 years as she had been private paying to a facility. For you, it could be that since you've been private paying so all the lookback needed is 2 mos. if so, again consider yourself fortunate!
does this AL have a NH as part of the complex or has an affiliated Nh? Ask about how they deal with the transition form AL to NH. Hopefully you never need NH level care but if you do it's good to know that a system is set up to do this.