Upcoming Changes to NY Medicaid 2022-23

Upcoming Changes to NY Medicaid 2022-23

Medicaid is operated on both federal and state levels, which provides a range of benefits in medical and health. Medicaid primarily is for individuals who suffer from chronic illness, are in cognitive or physical decline, injured/disabled, and require consistent medical treatment. Laws surrounding who qualifies for Medicaid change constantly, meaning it’s necessary to stay informed on the latest changes to be aware of your eligibility status. Below are some new and upcoming changes to Medicaid.

Upcoming Changes to Medicaid

Upcoming Changes to Medicaid in 2022:

Independent Assessor for Home Care - In Effect May 1, 2022

As of May 1 2022, Medicaid applicants over the age of 18 applying for Personal Care or Consumer Directed Personal Assistance Program (CDPAP) services will need to go through nurse assessments conducted by New York Independent Assessor (NYIA). The NYIA will conduct nursing assessments for “Immediate Need” applicants and others who apply to the local Department of Social Services, which is the Human Resource Administration (HRA) in NYC for personal care or CDPAP.

The NYIA will be conducting a clinical assessment in addition to a standard nurse assessment by either a doctor, physician’s assistant, or nurse practitioner. With these tests, the NYIA will determine if an applicant is eligible for personal care or CDPAP. If the applicant is deemed ineligible, they have Fair Hearing rights, meaning they can appeal their decision.

If the NYIA deems the applicant eligible, they are referred back to their local Medicaid office. The previous assessments will then be used to determine how many hours of personal care or CDPAP should be authorized. If you are approved for over 12 hours of personal care a day, the Medicaid Office or plan must refer the case back to the Independent Assessor for a third assessment, which is an Independent Medical Review (IMR). An IMR is used to determine whether the proposed plan of care is safe and can maintain the health of the applicant when they are home.

Increases in Medicaid Eligibility of Applicants 65+ and Blind/Disabled Individuals - In Effect January 1, 2023

New York Governor Hochul and State Legislature passed four increases in Medicaid eligibility for New Yorkers who are 65+ blind, or disabled in the NYS budget. Below are the four changes that will go into effect:

  • Medicaid Asset Limit has increased by nearly 50%
  • Medicaid Income Limit has increased to the same amount used for Modified Adjusted Gross Income (MAGI) Medicaid for younger people (138% Federal Poverty Line or “FPL”)
  • Medicare Savings Program: Qualified Medicare Beneficiary limit increased from 100% to 138% FPL. Individuals with higher incomes not exceeding 186% FPL will be eligible for QI-1.
  • Undocumented Immigrants Age 65+ will not be eligible for full Medicaid benefits as opposed to only “emergency” Medicaid

New Medicaid Limits in 2023 for 65+, Blind, & Disabled

Benefit Federal Poverty Line % SINGLES COUPLES
2022 2023 2022 2023 2022 2023
Income Limit Per Month
Medicaid 82% 138% $934 $1,563 $1,367 $2,106
QMB 100% 138% $1,133 $1,563 $1,526 $2,106
QI-1 135% 186% $1,529 $2,107 $2,060 $2,838
Medicaid Asset Limit $16,800 $28,134 $24,600 $37,908

Public Health Emergency - Extended Through July 2022

The Biden administration extended the COVID-19 Public Health Emergency on April 13, 2022 for 90 days. This means that the government is prohibited from discontinuing or cutting funding for Medicaid through July 2022. 

This means restrictions on eligibility cannot be implemented before October 1, 2022, which would include the 30-month “lookback” that would disqualify applicants from obtaining home care benefits, or require applicants from needing physical assistance with 3 activities of daily living or two if diagnosed with dementia in order to qualify for CDPAP.

For more information on NY Medicaid changes from 2022 to 2023, contact the Law Office of Inna Fershteyn at 718-333-2395.

6 Medicaid Planning Mistakes People Make

Medicaid is one of the largest medical insurance programs in the nation. This program is intended to assist low-income individuals who require financial needs in paying the costs of their healthcare. Medicaid is beneficial for seniors, disabled individuals, and those who are unable to simply cover medical care costs out of pocket. There are a variety of benefits to receiving Medicaid coverage, especially at a time when a loved one begins to age and needs additional help with their daily activities. A common fear among many elderly individuals is that they will not be able to afford long-term care and will have nobody to look after them in their time of need. Those familiar with nursing homes are aware of the massive price tag of $90,000 a year for care. Medicare will not cover these costs, thus it is important that individuals apply for Medicaid coverage prior to the need for long-term care arising. The same financial issue is present when elderly individuals attempt to pay for the costs of in-home care out of pocket. In most cases, it is unlikely that a family will be able to afford more than a year of care without Medicaid if they are in the low or middle class. Applying for Medicaid will minimize the pressure of having to pay the entire cost of care, thus it is recommended that you and your loved ones reach out to an Elder Law Attorney to begin your Medicaid Planning journey in advance. The attorney will guarantee that you are aware of the common mistakes and traps associated with independently Medicaid Planning without the guidance of an experienced attorney.

6 Medicaid Planning Mistakes People Make

Applying for Medicaid can be a challenging and complex process as previously mentioned, and without the knowledge of a professional, many mistakes can be made that could compromise your eligibility.

Top 6 Medicaid Planning Mistakes: 

  1. Applying for Medicaid too Early: The consequences of applying for Medicaid coverage too early includes a longer ineligibility period and spending much more money than if you applied at the appropriate time. You should wait to apply until you are certain that you meet all of the criteria and requirements. For example: If you made a generous gift to a loved one four years ago, you should wait for the five year lookback period to finish prior to applying for coverage. If you do not wait the designated amount of time, you risk being rejected for Medicaid coverage and having to pay the costs out of pocket for a longer period of time. Consult with an Elder Care attorney to discover the most appropriate time to apply for medicaid to ensure that you are granted coverage. 
  2. Applying for Medicaid too Late: It is common for individuals to procrastinate on applying for coverage and only apply when medical care is an absolute necessity. If you apply too late you are missing out on months of eligibility. This means that you are most likely using assets you have saved for your spouse or children on medical costs. Applying at an earlier period in time could make all the difference when it comes down to spending your entire life savings on medical costs. For example: If you needed Medicaid to cover your nursing home costs in July, but only filed your application in December, you will not receive full coverage to cover the costs of care. This would result in a massive financial burden on you and your family when it comes to covering the costs of the months that Medicaid will not cover because the application was filed too late. 
  3. Giving Away Assets too Early: Make sure that you consider all of the consequences of giving away your assets too early before giving your children the assets. Poorly planned gifts are the easiest way to jeopardize your Medicaid coverage. Medicaid will not apply for nursing home care for a certain number of months after giving a gift to your children because you will not meet the Medicaid eligibility qualifications. For example: If you give a gift to your children on Friday and then apply for Medicaid the following Monday, you will be rejected due to the Medicaid transfer penalty. Now you will need to get the money you gave your children back so that you can afford your medical costs. However, there is no guarantee that the money is readily available, as your children could have already spent it. Consult with an attorney to understand the five year lookback period prior to making a gift you may regret. 
  4. Thinking it is too Late to Plan: It is never too late to plan for your or your loved ones future. Even if your loved one is already enrolled in nursing home care, you may still apply for Medicaid in the effort to obtain coverage for at least some of the costs of care. Scheduling an appointment for a consultation with an experienced Elder Care Attorney is the first step to beginning your planning journey. The attorney will take the time to walk you through the process and answer any questions you may have during the process. It is never too late to start thinking about your Medicaid planning process. 
  5. Ignoring Safe Harbors Created by Congress: There are specific transfers of assets that you may partake in without risking the loss or rejection of Medicaid coverage. These transfers include, but are not limited to transfers to disabled children, caregiver children, and certain siblings. Additionally, you are able to transfer assets into a regular trust in the case that you are disabled and under the age of 65. This would be considered a pay back trust and would not jeopardize potential Medicaid coverage. In the case that you have a disability and are over the age of 65, you can still place your assets in a trust, but this trust is called a pooled-disability trust. An Elder Care Attorney can provide you with more information on transferring your assets and different types of trust in relation to obtaining Medicaid coverage. 
  6. Not Consulting an Attorney: There is no greater mistake than choosing not to consult an attorney, as an attorney is trained and experienced in the field and can update you on any rules or regulations you are not familiar with. Hiring an attorney will reduce the stress of having to file for Medicaid independently, for the process is very difficult and time consuming. In most cases, the questions are very difficult to understand and there is a specific way of responding to the questions in the application. Without an attorney, you are much more likely to make mistakes in your application which could jeopardize your ability to receive coverage. Some mistakes cannot be fixed, so it is important to ask any questions you may have and inquire about the best way to fill out the application to demonstrate your financial need.

For further Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2395 to effectively protect your assets from Medicaid.