Proposed 30-Month Medicaid Lookback Period in New York State– What It Could Mean for Community-Based Long-Term Care Recipients
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 Community Medicaid lookback period for non-institutionalized has not yet received final federal approval, but applicants should nevertheless prepare for its potential impact.
Background
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, the New York State legislature enacted a 30-month lookback period for community long-term coverage in New York for the first time and included a transfer penalty. New York submitted a request to the Centers for Medicare & Medicaid Services (“CMS”) to approve this change in state law. Additionally, implementation was delayed due to prohibitions against new Medicaid restrictions imposed by the federal government during the covid-19 pandemic. Moreover, NY Department of Health officials indicated that they needed more time to implement new procedures and train staff on the new law. It now appears likely that the transfer penalty and thirty-month look-back period may be implemented before the end of 2025. Review the proposal here.
Significance & Consequences
If the proposed 30-month community Medicaid lookback period in New York 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 Medicaid’s nursing home lookback period, 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 Medicaid coverage for Community Medicaid services would be denied. A New York Medicaid home care lookback period 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.
What You Can Do
The implementation of a 30-month lookback period for home care benefits in New York 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 those looking to receive Medicaid Services. Contact Sara L. Keating at (914) 287-6110 or skeating@bpslaw.com.