A new law, recently passed by the New York State Legislature and signed by Governor Andrew Cuomo, will have a significant impact for anyone receiving Personal Care Services or Home Care services through Medicaid. Among these changes are the imposition of a “look back” period for determining whether a person meets the requirements to be eligible for the Medicaid Home Care program. Previously, there was no “look back” period for the Medicaid Home Care program. There are also changes to services under the Consumer Directed Personal Assistance Program (CDPAP) and Personal Care Services (PCS). All these changes will be effective April 1, 2021.
Medicaid Home Care Services “Look Back” Period
Medicaid Home Services refers to the programs under Medicaid that administer healthcare to people in their homes. To be eligible for certain categories of Medicaid Home Services, you must be under a certain income and resource thresholds. The new law imposes a “look back” period of 2.5 years (30 months) for transfers or gifts made by the applicant, with a penalty imposed for any uncompensated transfers or gifts that occurred within that 30-month look back period. Therefore, if a home care applicant applies for Medicaid home care, the local department of social services will look at all financial transactions that occurred within 30 months of the date a person applies for Medicaid. If within that 30-month period, the applicant made gifts or uncompensated transfers, then a Medicaid penalty will be assessed. A Medicaid penalty is a period of Medicaid ineligibility.
CDPAP/PCS Eligibility Requirements
Additionally, there is a change in the requirements for the CDPAP and PCS programs. To be eligible for those programs, an applicant must need assistance with at least three out of six Activities of Daily Living (ADLs). Activities of Daily Living (ADL) include:
- Bathing and showering
- Personal hygiene and grooming
- Toilet hygiene
- Functional mobility
However, if you have a diagnosis of Alzheimer’s Disease or dementia, you only need to demonstrate needing assistance with one ADL to meet the eligibility criteria for CDPAP or PCS. To be eligible for care under CDPAP or PCS, you must have a plan of treatment from a “qualified independent physician selected or approved by the Department of Health,” not your regular physician.
DOH to Take Over Assessment/Approval of CDPAP and PCS
The Department of Health (DOH) will be taking over the assessment and approval of individuals for CDPAP and PCS programs, including the determination and approval of billable hours. The DOH will also be developing an assessment tool to make these determinations, which is set to go into place on April 1, 2021. The full takeover of the program is to occur by October 21, 2022.
There are also numerous other changes implemented by the bill. If you require assistance with any of these issues, or are facing legal difficulties related to Medicaid, please contact an attorney with experience in Medicaid cases. The attorneys at Hobson-Williams, P.C. have extensive experience assisting with asset protection and assisting with Medicaid applications for Home Care and Nursing Home Care and are dedicated to securing the best outcomes possible for their clients. With offices conveniently located in Queens, Brooklyn and the Bronx, the firm is dedicated to providing high quality legal representation. Call (718) 210-4744 to arrange a consultation, or visit our contact page.