Tanya Hobson-Williams, attorney at law at Hobson-Williams, P.C., says New York State’s new budget changes eligibility rules for home care services paid for by the Medicaid program in the State. The new law creates a “lookback” period that affects how the finances of ill and elderly people will be evaluated for their eligibility to receive Medicaid to pay for home care services. Ms. Hobson-Williams says the effect of this new law is that it will be more difficult for those who need financial assistance to obtain Medicaid for home care services.
Previously, there was no “lookback” period for the Medicaid home care program. However, on April 1, 2020, the state passed a bill that now includes a thirty (30) month lookback period for all home care service applications, effective October 1, 2020. 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 over the last 30 months from the date of application. 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.
It is presumed that these penalties will be imposed for any transfers or gifts made during or after the lookback period and will be calculated the same way that penalties are calculated for nursing home Medicaid. Additionally, personal care services/home care will only be made available to those who require assistance for at least three daily activities of living (these include eating, bathing, and getting dressed, among others). Only those diagnosed with dementia and/or Alzheimer’s disease will receive care if they require assistance for only one activity of daily living.
Further, the New York State Department of Health will place a moratorium on processing and approving applications for managed long-term care plans from now until March 31, 2021. During the moratorium, the agency will have the authority to determine whether managed long-term care plans not affiliated with Medicare are necessary, and impose an enrollment cap for each managed long-term care plan.
“Starting in October 2020, if a home care applicant made any gifts or uncompensated transfers during the 30-month period prior to applying for Medicaid, then a Medicaid penalty will be assessed,” Ms. Hobson-Williams says. “We await regulations and guidance on how these transfer rules will be applied to home care cases.”
“These new laws were enacted to save New York State money, unfortunately, at the expense of those needing home care services,” Ms. Hobson-Williams continues. “As a result, fewer individuals will be eligible for home care services paid for by Medicaid.”