New York State has proposed significant changes to Medicaid that could have major implications for individuals applying to receive home care or assisted living services. Originally expected to be implemented in March 2025, New York’s 30-month lookback period for non-institutionalized individuals applying for Community Medicaid has not yet received final federal approval, but applicants in New York should nevertheless prepare for its potential impact.
Previously, there was no lookback period required for individuals seeking Community Medicaid services. This allowed many seniors and disabled individuals to preserve their assets while receiving the care they need. However, in 2020, New York enacted a 30-month lookback period and transfer penalty for community long-term coverage for the first time. Although these regulations have not yet been implemented, New York has submitted a request to the Centers for Medicare & Medicaid Services (“CMS”) to approve this change. Implementation was expected to be delayed until at least March 2025 to allow for time to train personnel on the new procedures and to obtain CMS approval. Additionally, CMS must confirm that New York State has utilized federal funds from the American Rescue Plan (ARPA), as the state is not permitted to impose new Medicaid eligibility restrictions until these funds have been expended.
If the proposed 30-month lookback is enforced, applicants will face various challenges that will require guidance. These challenges may include whether they can shelter excess income through pooled income trusts and how the transfer penalty start date will be calculated. Similar to the regulations for nursing home care applicants, it is likely that Community Medicaid applicants would have to provide a comprehensive accounting of all transfers made within the 30-month period immediately preceding their application date in order to determine their eligibility to receive said services. Any uncompensated transfers, such as gifts to family members (other than a spouse), property transfers, or assets placed in trust, could result in a penalty period during which Mediaid coverage for Community Medicaid services would be denied. This could result in delayed access to critical services such as adult day health care, assisted living programs, certified home health agency services, personal care services, and private duty nursing.
The implementation of a 30-month lookback period for home care benefits represents a significant shift in Medicaid policy, and individuals planning to apply for Community Medicaid should take proactive steps to protect their financial future.
The Elder Law and Special Needs Practice Group at Bleakley Platt & Schmidt, LLP is dedicated to helping their clients navigate these complex changes in the law and assisting clients looking to receive Medicaid Services. Contact Sara L. Keating at (914) 287-6110 or skeating@bpslaw.com.
