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NYS Community Medicaid will have a financial “look back” starting October 1, 2020

New York State Budget – Medicaid Update: Good News/Bad News

On April 3, 2020, Governor Andrew Cuomo signed the approved 2020/2021 budget for New York State. As it often happens in matters of budgets and law-making, what comes out is often a mixture of good news and bad news.  This year, the budget does not disappoint in that regard.

The Good News

  • Spousal refusal survives – Spousal refusal, which seems to be on the chopping block every year, has again staved off elimination. Spousal refusal is critical for married couples to allow the spouse who is not applying for Medicaid, to retain his or her own income and assets to live on – even if those amounts exceed what Medicaid permits
  • Spousal Resource Allowance unchanged – There was a push to reduce the spousal resource allowance (what a non-Medicaid spouse is permitted to retain in assets) from the current minimum of $74,820 to $25,728. Thankfully that push failed so the minimum remains at $74,820.

The Bad News

  • Financial “look back” for community Medicaid – Up until now, there has been no official “look back” when someone applies for Community Medicaid. 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. Effective with applications filed as of October 1, 2020, there will now be a 30-month look back, similar to that of a Medicaid nursing home application. If the applicant made any non-exempt transfers, the applicant will be subject to a period of ineligibility (“penalty period”) based on the amount of the transfers.

This process will apply to home health care services, private duty nursing, personal care and the assisted living program (“ALP”).

Unfortunately for those requiring services in the community, this will be potentially disastrous. There will now be the added time and stress for the family in retrieving 30 months of financial documentation, also coupled with long delays in processing these more voluminous and complicated applications by the Department of Social Services (already overloaded with cases).  All of this will lead to longer waiting times for a client to get the services they need and needing to privately pay for those services during this lengthier application process.

At Russo Law Group, we remain ready and able to serve our community and assist in getting through this process. Now more than ever, it is important to seek the advice of an experienced elder law attorney to preserve your dignity and protect your assets.

This Post Has 2 Comments

  1. My mom is 91 and recently diagnosed with Alzheimer’s. I am in need of advice regarding community Medicaid to see if she is eligible for an in home aide. The home is deeded in her children’s names. She has an income of approximately 38,000 yr.

    1. Hi Mary Jane,

      Beginning October 1, 2020, the laws governing qualification for this benefit changed. An applicant must provide verification of financial assets for 1 to 30 months, depending on when you apply. Starting January 1, 2021, the applicant will have to provide three (3) months of financial documentation with an additional month added each of the following months until April 2023, at which time an applicant will be required to provide thirty (30) months of documentation. This is referred to as the “look back” period.

      In addition, for 2020, applicants cannot have assets in excess of $15,750 (2020), with some exceptions. Income also cannot exceed $895 plus the cost of their supplemental health insurance premiums. Any excess income will be paid either to a pooled income trust or to Medicaid.

      Additionally, an applicant must also have a need for assistance with activities of daily living. Depending on the applicant’s medical diagnosis, the need for assistance has to be anywhere from two or more activities in order to qualify for the benefit.

      Since Medicaid is a financially means-tested program, we can assist your mom with qualifying for Medicaid. We can also assist with filing the Medicaid application for home care services. Our firm assists hundreds of clients each year with Medicaid eligibility.

      Please contact us at 516-683-1717 for an appointment with an elder law planning attorney.

      Planning ahead can ensure the highest quality of life for you and your loved ones. We look forward to hearing from you.

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