More Changes to Community Medicaid Proposed

A bill has been introduced in the New York State Assembly to clarify and amend a recently enacted bill imposing a 30-month look-back period for community Medicaid effective October 1, 2020.  The cumulative effect of the proposed changes and clarifications is to mitigate some of the anticipated harsh effects on Medicaid home care applicants of the sudden introduction of the 30-month look-back period.


Changes Proposed to Look-Back Law

The amendment would make the following changes to the application of the 30-month look-back period to community Medicaid:

  • Applies the 30-month look-back period only to transfers or gifts made after October 1, 2020;
  • Exempts transfers where all assets transferred for less than fair market value have been used on behalf of the individual;
  • Permits an immediate needs applicant to attest that no transfers that would make him/her ineligible were made in the 30-month look-back period and provide documentation later;
  • Defines the period of ineligibility for community Medicaid based on asset transfers as either the first day of a month during or after which assets have been transferred for less than fair market value, or “the first day the otherwise eligible individual  is functionally  eligible  for services for which medical assistance would be available based on an approved  application for such care but for the provisions of subparagraph three of this paragraph, whichever is later, and which does not occur in any other periods of ineligibility under this paragraph.”
  • Exempts transfers to a family member or informal caregiver made before the Medicaid application, if:
  • the transfer is in exchange for care services provided to the client or his/her spouse;
  • the client or his/her spouse had a documented need for the care services;
  • the fair market value of the asset transferred is comparable to that of the care services provided; and
  • based on the type of services provided, the time for which care services are claimed is reasonable.


Effect of Changes

The recently enacted changes as well as the pending proposed changes to community Medicaid in New York must be considered by individuals serving as guardians to elderly or disabled people who need or may imminently need home care.  In many cases, it may make sense to engage in Medicaid eligibility planning and to apply for community Medicaid for individuals who need home care.

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