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New Changes to New York Medicaid Affects Home Care Benefits with a 30-Month Look-Back Period


Changes in New York State’s Medicaid program place individuals who need home care in a costly situation. The implementation of a 30-month look back on finances may lead to delays in qualifying to receive home care or assisted living services. Acting quickly and planning for Medicaid may save seniors and disabled individuals from having to pay out-of-pocket for the assistance they need.

Recent changes in the New York State Budget create new difficulties for anyone applying for Community Medicaid after October 1, 2020. In fact, disabled individuals and the elderly may find it difficult to obtain the services they need without a long waiting period. Your eligibility and benefit coverage may be different than you expected due to the new changes in policy, particularly if you fail to focus on Medicaid planning now. The approval process may also be delayed due to the extra paperwork and processing time involved.

Upcoming Changes to Home Care Benefits in New York City

The most notable change in Community Medicaid is the 30-month look back on financial records. Applicants must provide a full accounting of every uncompensated transfer of assets beginning with those that took place on or after October 1, 2020. Uncompensated transfers will affect applications negatively. An uncompensated transfer includes gifts to family members, asset or property transfers, and money transfers to a trust fund

Even though the look back involves 30 months of records, it does not include any transfers of property/funds prior to October 1, 2020. This means that if you act quickly, you can still make changes to your financial situation without incurring a penalty. Community Medicaid includes both home care services and assisted living services.

Assets Impacting Applications Negatively

Medicaid planning has never been as important as it is today. With the newly implemented change, financial transfers take on a bigger importance in determining exactly when an applicant qualifies to receive Medicaid services without having to pay out-of-pocket.

What Happens if You Enter the Penalty Period?

When your financial records indicate that you have made uncompensated transfers, you enter a period of ineligibility, also referred to as the penalty phase. Medicaid calculates the length of the penalty period in months using a specialized formula. The amount of your transfer is divided by the regional rate for care in your New York location

Medicaid Planning to Avoid the Look-back Period for Home Care Benefit Applications

Medicaid planning is important if you want to keep your assets in the family. You still have time to make changes as long as you act now. If you don’t make any changes and you are applying on January 1, 2021, you only need to supply financial records for three months – October, November, and December of 2020. It’s important to note that policymakers wanted to require a 5-year look back for Community Medicaid applicants, similarly to Nursing Home Benefit applicants. Changes may still occur in the future.

If you are ready to apply for Community Medicaid services or you have questions about the upcoming changes, please consult one of our experienced attorneys. Our New York firm strives to give our clients the guidance they need to make informed choices about their estate and asset protection plans that help to preserve their quality of life.