Medicaid is the main source of long-term care coverage for many people. There are many factors to consider when applying for Medicaid, and this is widely due to the eligibility requirements that Medicaid has. One of the main components of qualifying for Medicaid is that they look at applicants' previous financial information for a limited period of time. This is commonly called the Medicaid Look-Back Period. In general, while determining Medicaid eligibility, any gifting of assets within the look-back period will deem the person ineligible for Medicaid for a period of time.
All states, with the exception of California, have a five-year lookback period on applications seeking Medicaid for nursing home care. However, New York State recently adopted a law imposing a lookback period for long-term home care as well. Therefore, people need to take careful consideration before deciding if they need Medicaid for nursing home care and/or long-term home care in NY. Although the lookback period for long-term home care isn’t as long as five years, it can still negatively impact people who need Medicaid benefits sooner rather than later.
For long-term home care, the Medicaid lookback period is at least 15 months. Medicaid will examine asset transfers dating back at least 15 months before your application. This new NY Medicaid transfer rule will begin on October 1, 2022. After the date, anyone applying for Medicaid long-term home care benefits will be subject to the lookback period and might have to provide records up to 2.5 years before the date of application.
Here Are Some of The New Transfer Rules:
- Applicants and their spouse filing after October 1, 2022, must provide all financial records within the lookback time frame (at least the last 15 months) even if the spouse does not currently need Medicaid services.
- The lookback period will, at some point, increase to 30 months (2.5 years). The increase will be gradual.
- Any asset sold, gifted, or transferred below a fair market value during the lookback period could result in a period of ineligibility for Medicaid.
- Applicants will be required to submit a Department of Health (DOH) medical form. A licensed doctor must indicate their belief that the applicant meets the medical requirements needed to qualify for homecare. This requirement is especially important because the DOH demonstrates that a transfer penalty can be activated in the month that an applicant is both financially and physically eligible for Medicaid home assistance. A transfer penalty is incurred during the timeframe that an applicant fails to comply with the Look Back Period. When the penalty’s duration ceases, an individual can then reapply for Medicaid.
- The Department of Health allows for an exception to the transfer penalty if the applicant’s circumstances fall under the definition of “undue hardship.” Denial of home assistance falls under this definition. However, this definition does not extend to community-based eligibility.
- Applicants who file their Medicaid applications before October 1, 2022, will NOT be subject to this lookback and will NOT incur transfer penalties. Early filing is key to getting the benefits you need for home care services.
Exceptions to the Transfer Penalty
Transfer of a Home to:
- Children under the age of 21 or legally blind/disabled of any age
- A caretaker Adult child that resided in the applicant’s home for at least two years and can prove that their care allowed the applicant to live at home rather than in a medical facility
Transfer of Property Other Than a Home to:
- Individual’s child who is legally blind/disabled
- A trust established for the benefit of an individual under 65 years old who is disabled
- Transfer of an asset that does not accumulate a penalty
- Assets were transferred for a reason other than to qualify for Medicaid nursing home costs
If you need consulting on Medicaid eligibility for long-term home care, please contact the Law Office of Inna Fershteyn at (718) 333-2395.