New York Delays Restrictions on Medicaid Eligibility for Home Care

APPLICANTS SHOULD TAKE ADVANTAGE OF ‘EXTRA TIME’ TO APPLY WHILE FAVORABLE RULES REMAIN IN EFFECT

by Louis Pierro and Frank Hemming III

For many years, New York didn’t have a look-back period for Medicaid home care. That’s right, an applicant could give away all his or her assets and then apply for Medicaid community-based care the following month, without penalty.

But that is now changing, with new rules passed in New York that will limit eligibility and access for new applicants. For transfers made on or after October 1, 2020, there is a new 30-month lookback for Medicaid home care. Applicants who transferred assets during this new lookback period will face a period of ineligibility when Medicaid will not be available to them.

If there is good news in this bleak scenario, it’s that the ‘start time’ when new rules take effect has been pushed back. As of this writing, the enforcement of this new lookback period has been delayed, and only applications filed after April 1, 2021, will be subject to the new rules and penalty period. This delay is the result of a variety of reasons, including challenges in the health care system dealing with COVID 19.

As a result of this new delay, there is a short period between now and March 31, 2021, where planning can be done and applicants can begin service without the new penalty or other stringent rules.

This brief window of opportunity benefits people that have chronic conditions and need home care benefits now. If you apply between today and the end of March, there are no penalties or delays because local Medicaid offices aren’t enforcing the new rules yet. For those applicants, the old rules still apply, such that if you make asset transfers such as moving a property into a Trust, it won’t be counted against you, but only if you apply for Medicaid prior to April 1, 2021.

What if you don’t need Medicaid benefits between now and April, but you’re doing legal planning because you expect to need home care benefits at some point in the future? In that scenario, you will have to contend with the new lookback period if and when you eventually do apply for Medicaid. For those living at home who are unsure whether they quality now, our firm offers a comprehensive assessment by our Care Coordinators Susan Vail and Nora Baratto to determine eligibility.

In addition to the new rules regarding asset transfers, New York State is also changing the medical criteria that an applicant must meet in order to receive Medicaid assistance at home. Applicants will now have to prove they need assistance with three Activities of Daily Living (ADLs) instead of two. ADLs include tasks like bathing, dressing, eating, and toileting. In addition, Medicaid will require that an independent physician certify that the applicant needs care at home, instead of an applicant’s own physician assisting with the process.

Nursing Home Care

With regard to nursing home care, New York state will continue to impose a five-year lookback period to qualify for nursing home Medicaid benefits, the new rules mentioned above only apply to Medicaid benefits covered in the home.

Medicaid, unlike Medicare, is a means-based program, which means that you are only eligible for if you have very few assets. With careful planning, however, your assets can be protected.  If you are interested in learning more about Medicaid asset protection, go to www.pierrolaw.com and take advantage of our Guides and watch our most recent webinar here. To take the next step and get your individual plan done now, schedule a free consultation with the attorneys at Pierro, Connor & Strauss.