Financial Look-Back Period for Community Medicaid in New York

The Community Medicaid laws for New York are changing. One of the changes, effective October 1, 2020, is that there is now a two-and-a-half-year look-back period for this type of Medicaid. During this look-back, there will be a review of your past financial resources.

Community Medicaid is one of the two types of Medicaid in New York. The other type is Nursing Home Medicaid. Community Medicaid offers coverage for things like durable wheelchairs, prescription drugs, lab tests, adult day care, x-rays, occupational therapy, and more.

The coverage is intended to help people remain in their own home. It is also available to people in Assisted Living.

There Is Good News and Bad News

There is always a push and pull in the state budgets. For the 2020/2021 budget, spousal refusal and the spousal asset limit were upheld. However, there is now a 30-month look-back period. What this means will be detailed below.

Spousal Refusal Upheld

In New York, a spouse can still refuse Medicaid if the other needs this coverage. They can retain their assets and income if the other is on Medicaid. This was on the chopping block, but it has thankfully maintained its place in the Medicaid eligibility law.

Spousal Resource Allowance Is the Same

This provision maintains that the non-Medicaid spouse can have a minimum of $74,820. There was an attempt to lower this minimum to $25,728. The higher minimum will help provide for a lot more elderly and disabled applicants. (note – these numbers are as of the 2020 ruling and subject to change over time)

The New Look-Back Period

The new look-back period is 30 months. Up until this change, people could transfer assets prior to applying to Community Medicaid. There would be no issue with their eligibility. There has been a five-year look-back period for Nursing Home Medicaid.

If there has been a transfer in assets during the 30 month look-back period, the applicant will be subject to a penalty waiting period under the new law.

This will likely make it difficult for the Department of Social Services. They will have more cases to add to their already overburdened schedule.

The change will affect many applicants who might require coverage right away. They will be stuck paying for things out of pocket during their review and/or penalty period.

How the Look-Back Period Is Applied

The look-back period is applied immediately from the day your Community Medicaid application is sent in. It applies to applications for long-term care services.

These services are defined as home health care services, private duty nursing homes, personal care services, assisted living program services, and consumer-directed personal assistance programs, and managed long-term care plans.

What Does the Law Mean?

Essentially, the change in eligibility means that applicants can no longer give money to children and then qualify for Medicaid immediately. They will have to pay for costs of insurance out of pocket during a penalty period. They will have to prove eligibility during this period.

What it really means is that before you do anything related to long-term care, you should contact Kyle Steller to figure out a plan.

Consult with an Elder Law Attorney

Fill our form to schedule a free consultation with an experienced Elder Law Attorney. If you need guidance with wills, trusts, medicaid planning, asset protection or any other service Kyle Steller provides. Kyle serves families and individuals in Ulster County, Dutchess County and throughout the Hudson Valley of New York. Schedule your consultation using the form here, or call Kyle at 845-489-8712