New Rules for Community Medicaid

,

Provisions of the recently passed New York State Budget will make it far more difficult for many to become eligible for services under the Community Medicaid program. The new rules impose a lookback period.

This is a major change to the current regulations, which allow access to home care Medicaid benefits without the imposition of any penalty period for transfers made any time prior to the application. The new rules are scheduled to go into effect on October 1, 2020, meaning applications made within the next 5 ½ months will not be subject to the new restrictions.


Here are some of the most notable changes to Medicaid eligibility criteria:
There will be a 30-month lookback period imposed on community Medicaid applications. Applications made between now and October 1, 2020 will be evaluated under the current regulations, which impose no penalty period for transfers made prior to an application for Community Medicaid. Under the new rule, any non-exempt transfer made during the lookback period will result in the imposition of a penalty period; individuals will be responsible for privately paying for care during the length of the penalty period;


Under the new rules, in order to be eligible for long-term care services in the community (home care) using the Consumer Directed Program (CDPAP) or personal care services (PCS), an individual must require assistance with 3 activities of daily living (ADLs) instead of the current rule which allows eligibility if the individual needs assistance with only 2 ADLs. Thankfully under the new rule, those individuals with Alzheimer’s or Dementia will only need to demonstrate a need for assistance with one ADL; and For PCS and CDPAP services, a “qualified independent physician selected or approved by the Department of Health” (not the treating physician) must determine the plan of care for the individual.


These new regulations will have a tremendous impact on Medicaid planning in New York State. One piece of good news, however, is that transfers to a non-applying spouse continue to be an exempt transfer, and spousal refusal can still be employed to access benefits. Transfers of a residence to certain individuals without the imposition of a penalty are still a possibility under the new rules.

Changes to the New York State Budget

,

We hope you and your families well and safe. We want to inform you of recent changes to the New York State budget which may significantly impact your need for home care services paid for by Medicaid (also known as Community Medicaid).

New York State has passed the 2020 State budget Bill which includes radical changes to the statewide community Medicaid program covering home and community-based services:

  • Starting October 1, 2020, all new applications for Medicaid community-based (home care) benefits will be subject to a 30-month (two-and-half-year) lookback period when analyzing an applicant’s resources and income. This requirement is a drastic change from the prior one-month lookback period.
  • If transfers are found within 30-months (two-and-half-years) prior to the date of submission, a transfer penalty or waiting period will be applied before services can be granted to that individual.

The anticipated effective date of this new rule is October 1, 2020; therefore, all Medicaid home care applications filed after October 1 will have to provide 30-months of financial statements for all resources.

If you are considering applying for home care services in the near future, we strongly recommend that you contact us as soon as possible to discuss preparation of your Medicaid home care application so that it can be filed before October 1, 2020, and avoid the new lookback requirements and possible penalty period.

This change will likely cause the application process to take longer, and we do not want you to be delayed in your receiving much-needed benefits as past transfers will now affect your eligibility. Please note that the lookback period for Medicaid nursing home benefits remains unchanged at a full 60 months (5 years).