|In the shadows of the COVID-19 pandemic, Governor Cuomo and the New York State Legislature quietly made significant changes to New York’s Medicaid rules, making it harder for New Yorkers to obtain Medicaid benefits for long-term care.|
Community Medicaid, the program which provides care for clients at home, represents the biggest change under the new law. Up until now, there has been no official “look back” for applicants. In other words, if assets were transferred prior to applying for Community Medicaid, there were no ramifications to that person’s eligibility for Community Medicaid.
However, applications filed as of April 1st, 2021 will require a 30-month (2 ½ years) look back, similar to that of a Medicaid nursing home application. Currently, NY Medicaid has a 60-month look-back period for applicants for nursing home coverage, meaning that Medicaid “looks back” at the financial transactions made by the applicant seeking such coverage – and his/her spouse – in the prior 5 years.
In perhaps the biggest change that NY Medicaid has seen in many years, this two and a half year look-back will now likely work in the same way that the five-year look-back for Medicaid nursing home coverage does. When applying for community Medicaid, one will need to show that for 30 months prior, neither the Medicaid applicant nor their spouse transferred assets out of their name.
In addition, subject to reviewing the applicants’ finances during the 30-month period prior to application, Medicaid will impose a penalty period for “non-exempt” transfers.
A penalty period means that there will be a period of time during which Medicaid will not provide services. The applicant must then privately pay for services for the length of the penalty period BEFORE Medicaid will begin to cover the services.
This process will apply to home health care services, private duty nursing, personal care and the assisted living program (“ALP”). Unfortunately, for those in the community requiring services, this will be potentially disastrous. There will now be the added time and stress for the family in retrieving 30 months of financial documentation, coupled with long delays in processing these more extensive and complicated applications by the Department of Social Services (already overloaded with cases.) All of this will result in longer waiting times to obtain services and the need to pay privately for those services during this lengthier application process.
If you or a loved one needs assistance and wants to remain at home, it is imperative that you apply for Community Medicaid as soon as possible. Assuredly, many applications will be filed close to the April 1st, 2021 deadline. To avoid delays in processing and availability of caregivers applications for Community Medicaid benefits should be submitted as quickly as practical.
The look-back and penalty periods will be applied to applications received on or after April 1st, 2021. Applicants who apply before that date will not be subject to the look back or penalty periods, either at the time of application or upon their renewal or re-certification.
|This means that the time to plan is now.|
|If you have not created your estate and asset protection plans, now is the time to do so. Proactive planning has always been a recommended course of action when it comes to estate and asset protection planning. Often clients are able to preserve significantly more of their assets when planning ahead of time, rather than waiting until the need for Medicaid benefits arises.|
If you have already created your estate and asset protection plans with the focus on receiving Community Medicaid, now is the time to revisit, review and possibly revise your plans to ensure that they still achieve your wishes and desires.
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