What You Need to Know About Medicaid and the Lookback Period in New York

Serving Families Throughout Melville

Many people in New York with low-income status require Medicaid assistance to cover community-based long-term care (CBLTC) services. On March 25, 2021, the state of New York (State) submitted their Waiver Amendment Request – Application for 1115 Waiver Authority to Implement a 30-month Transfer of Assets Lookback for Community Based Long-Term Care Services (Waiver Amendment) to the Department of Health & Human Services, Centers for Medicare and Medicaid Services. New York’s Waiver Amendment utilizes a lookback period of 30 months for non-institutionalized individuals who are looking for coverage of CBLTC services. However, the COVID-19 pandemic forced changes to some of these regulations and how they affect applicants.

Elder law and estate planning attorneys have experience navigating New York’s complex Medicaid laws. A knowledgeable Medicaid attorney can help new public benefits applicants understand how the new lookback regulations will impact them.

What Is the Medicaid 5-Year Lookback Rule?

In 49 states and in D.C, the Medicaid lookback period is 60 months for Chronic Care/ Nursing Home coverage Medicaid. The lookback period is effective immediately following the Medicaid application date. The lookback rule allows Medicaid to review your finances for the 60-month period preceding your application for asset transfers made for less than fair market value. If any transfers are flagged, it may trigger a penalty period during which you will be responsible for covering your long-term care expenses. However, as mentioned above, New York will implement a 30-month transfer of assets lookback period for coverage of CBLTC services.

As a result of the lookback period, many New York Medicaid applicants may choose to transfer assets because of the program’s income and asset limitations for health care eligibility under Medicaid. New York has multiple Medicaid long-term care programs for seniors, including:

  • Institutional or Nursing Home Medicaid. The entitlement program is open to all eligible parties who need care in a nursing home.
  • Medicaid Waivers or Home- and Community-Based Services. This option is not part of an entitlement program, unlike nursing home Medicaid. The State has a limited number of participant slots, so waitlists are standard.
  • Regular Medicaid or Disabled, Aged 65 Plus, or Blind. This entitlement program offers multiple long-term care services for anyone who qualifies.

Medicaid Income and Asset Limitations

Though these programs have varying financial eligibility requirements, they have similar income and asset limitations. All three forms of New York Medicaid pose a $934 monthly income limit for a single applicant. The individual cannot have more than $16,800 in assets, including investments, savings accounts, checking accounts, cash, cash value of life insurance polices and stocks.

If married spouses are both applying for Medicaid, they cannot have an income exceeding $1,367 a month. Their asset maximum is $24,600.

It’s possible to earn too much or have too many assets to qualify for Medicaid long-term care, even if you or your loved ones cannot afford to pay for medical care without assistance. People may need to spend down or transfer their assets to meet Medicaid’s eligibility requirements.

There are rules for how a Medicaid applicant can spend down or transfer their assets. The lookback period’s purpose is to discourage people from giving away their assets specifically to qualify for Medicaid’s asset limit. That includes transferring assets to a spouse with no intention of applying for Medicaid home care or nursing care. If someone violates the lookback rule, the agency will include a penalty period of Medicaid ineligibility into its calculations for the applicant.

What Are New York’s Changes to the Medicaid Lookback Program?

The April 2020 State budget required Medicaid to cut its eligibility requirements and limit access to home care services for the 2020-2021 year. As a result, New York’s lookback period for home care and CBLTC services will change from zero months to 30 months before applying a penalty for regulation violators.

However, the Families First Coronavirus Response Act does not allow states to increase Medicaid program restrictions until the quarter following the end of the Coronavirus public health emergency. Though the State plans to implement changes to the lookback program, the new lookback period will likely delay until April 1, 2022, or July 1, 2022. While the lookback period will ultimately be 30 months (2.5 years) instead of 60 months as it is for Institutional Medicaid.

Filing a Medicaid application in New York on or after April 1, 2022, will likely subject you to a lookback. The lookback program’s extension creates the perfect opportunity for New Yorkers to apply for CBLTC Medicaid now without penalty.

If you or your family members need Medicaid to cover CBLTC services soon, now is the time to contact an elder law and estate planning lawyer. Since the program has an extended date, you or your loved ones may be able to transfer assets without incurring a penalty.

CBLTC Services Impacted by New York State’s Lookback Program

Enacted in the State’s 2020 budget, the State’s Waiver Amendment sets a 30-month transfer of assets lookback for those seeking to obtain Medicaid coverage of CBLTC services. The following are the CBLTC services that the State plans to impact by this initiative:

  • Assisted living program
  • Certified home health agency services
  • Personal care services
  • Consumer-directed personal assistance program
  • Limited licensed home care services
  • Private duty nursing services
  • Managed long-term care in the community

Contact an Elder Law and Estate Lawyer at SCHNEIDER, GARRASTEGUI & FEDELE PLLC to Learn More About the Medicaid Lookback Program

It can be challenging to navigate New York’s Medicaid requirements and New York’s lookback program, but an elder law and estate attorney from the SCHNEIDER, GARRASTEGUI & FEDELE PLLC law firm is here to assist you. Our firm has over 30 years of experience providing Melville, New York residents with quality comprehensive legal services.

Our law firm’s primary practice areas include Medicaid application and planning, probate and estate administration, elder law, and wills and trusts. Our mission is to advocate for our clients’ needs and protect their assets. Call (631) 519-9831 to schedule a consultation with one of our Medicaid lawyers or fill out our contact us online form here.

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The information in this blog post (post) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

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Melville, NY 11747
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