Drastic Changes to New York Medicaid Home Care to Start October 1

by Frank E. Hemming III, Esq., Senior Associate Attorney

We are sharing an important advisory about the future of New York State’s Medicaid program. Following the passage of the 2020-2021 State Budget, we now know there will be significant changes to how seniors and disabled individuals will become eligible for and receive Medicaid benefits in their homes.

Here is a summary of the changes:

Expanded “Lookback” for Community-Based Long-Term Care Services
Currently, there is no lookback for Community Medicaid (Medicaid Home Care).  This means that elder law attorneys can help families complete planning immediately, and long-term care services can typically begin in the home within a few months. However, as of October 1, 2020, that timeframe will no longer be possible. The new rules impose a 30-month lookback on all financial assets of the Medicaid applicant in order to be eligible for Community Medicaid. (For skilled nursing Medicaid, the lookback remains the same at five years). 

While we are still getting clarification from New York State on some of the details involved with the new 30-month lookback, this change will be catastrophic for seniors. Instead of getting needed care in the comfort of home, seniors who have failed to plan will be ineligible to receive help at home immediately and will be forced to spend down life savings and / or privately pay before Medicaid is available.

Changes to Medical Information needed to qualify for Community Medicaid
An individual must meet medical criteria as well as financial criteria to be eligible for Community Medicaid. Prior to October 1, 2020, an individual must need assistance with at least two Activities of Daily Living (ADLs) to be eligible for Medicaid benefits at home. Starting on October 1, 2020, an individual must need assistance with at least three ADLs to access Community Medicaid, or at least supervision with one ADL if the individual has an Alzheimer’s or dementia diagnosis.

In addition, in-home care services must be prescribed by an independent physician approved by the New York State Department of Health.  This will create challenges compared with the current system as new applicants will be forced to arrange an assessment with an unknown medical provider who is unfamiliar with the long-term health, past history and family situation.

Lastly, a new assessment tool will be implemented prior to April 1, 2021 to help Medicaid providers and local departments of social services determine the number of hours needed for in-home care. The new tool is supposed to identify how the needs of Medicaid recipients can be met through telehealth, family and social supports. However, if Medicaid will be leaning on new telehealth options, this presents a new unknown piece as to how Medicaid will be administered in the future.

“Spousal Refusal Still an Option”
A bright spot here is that the planning opportunity known as Spousal Refusal is still available. This means that a Medicaid applicant’s eligibility for Medicaid (in home or nursing home) does not take into consideration the assets or income of his or her “community” spouse, who often still lives in the home. 

Where Does This Leave You or a Loved One?
There is still a short period of time to take advantage of current favorable rules to qualify for Medicaid before the new, harsher rules take effect on October 1. 

If you have completed your long-term care or Medicaid planning before today, or move quickly before these proposals take effect, Pierro, Connor & Strauss can still help you or a loved one qualify for Medicaid benefits.

If you haven’t planned yet, do your planning now. Get the clock ticking on protecting your assets before these planning opportunities no longer exist. You can watch a video that I co-hosted with Lou Pierro at www.pierrolaw.com/videos to learn more. Call our office to start this process now at 1-866-951-PLAN.