Medicaid look back

New York’s Big Medicaid Change For Community-Based Long-Term Care Services: 30 Month Look Back Coming Soon.

New York proposed to amend its Medicaid section 1115 demonstration, also known as the New York Medicaid Redesign Team (MRFFCRAT) waiver.

The amendment seeks to implement a 30-month transfer of assets lookback period for coverage of community-based long-term care (CBLTC) services, and approval to exclude certain enrollees from these rules. This is similar to the current 60 month look back period for institutional based (nursing home and assisted living) Medicaid benefits. Currently, New York does not consider assets transferred in determining eligibility for community based long-term care services.

The earliest date that the state will seek implementation is March 31, 2024, due to the federal Covid-19 public health emergency declaration and the maintenance of effort requirements under the Families First Coronavirus Response Act (FFCRA). However, importantly, there has been an unofficial announcement that the look back period will not be implemented until at least 2025. These dates have been moving for quite some time and we will continue to monitor them.

What Are Community-Based Long-Term Care Services and Why Are They Important?

CBLTC services help individuals with chronic conditions or disabilities to live independently and avoid institutionalization. These services include personal care, home health care, adult day health care, private duty nursing, consumer directed personal assistance, and managed long-term care. CBLTC services are essential for improving the quality of life and health outcomes of many Medicaid beneficiaries, especially older adults and people with disabilities.

What is The 30-Month Transfer of Assets Lookback Period for Medicaid, Who Will Be Affected?

The 30-month transfer of assets lookback period is a policy that requires Medicaid applicants to disclose any transfers of income or resources that they or their spouses made within the 30 months prior to the month of application for CBLTC services.

If the state determines that a transfer was made for less than fair market value and was not for a valid purpose, such as paying for medical expenses or supporting a dependent, the state will impose a penalty period during which the applicant will not be eligible for CBLTC services.

What Are the Penalty Periods?

The penalty period is calculated by dividing the amount of the transfer by the average monthly cost of nursing home care in a particular region of the state, which ranges from $11,328 (Central) to $14,012 (Long Island). For example, if someone on Long Island transferred $280,240 to someone during the lookback period, their penalty period would be 20 months of ineligibility ($280,240 /$14,012 = 20 months). During the 20 months, they would be responsible for paying for services out of pocket.

The 30-month transfer of assets lookback period will apply to certain categories of non-institutionalized individuals who are aged, blind, or disabled and subject to non-magi budgeting rules. These include the ticket to work basic group, the ticket to work medical improvement group, and the medically needy aged, blind, and disabled.

The State is seeking approval to exclude individuals enrolled in Mainstream Managed Care and Medicaid Advantage from the 30-month transfer of assets lookback period, regardless of whether they are in a category that is subject to the lookback.

When is The New Rule Effective?

If the effective date for Community-Based Long-Term Care transfer rules is March 31, 2024, and an application CBLTC services  is made April 1, 2024, then a penalty period would be assessed for any transfers made in the previous 30 months.

New York’s addition of a lookback period for asset transfers when applying for Community Based Long-Term Care services brings its program in line with most of the other states. However, this change can have eligibility consequences for those who have too many assets when trying to qualify for Medicaid.

What Should You Do If You Need CBLTC Services and Medicaid?

You should definitely speak to a competent Medicaid planning attorney to avoid common mistakes which can impact eligibility and have possible tax consequences. A short consultation with an attorney can answer many questions and potentially save you thousands of dollars or get you qualified for Medicaid quicker.


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