When you, a parent, a spouse, or another loved one needs long-term care, the cost can put enormous pressure on you and your family. Fortunately, Medicaid may help pay for long-term care, but qualifying for benefits can involve complicated financial rules. One of the most important is the Medicaid look-back rule.
Families often ask what is the look-back period for Medicaid and whether giving away money or property will affect eligibility. In New York, the answer depends in large part on the type of long-term care you need. Nursing Home Medicaid has a 5-year (60-month) look-back. New York has also proposed a 30-month look-back for certain community based long term care (CBLTC) services. Importantly, that 30-month rule remains subject to federal approval and implementation.
Understanding the difference between these rules can help you plan and avoid decisions that could delay Medicaid coverage. And the best way to understand your eligibility and options is to speak to a trusted elder law attorney. Andrew Lamkin has 20 years of legal experience and is a leader in the elder law community. Contact the Law Offices of Andrew Lamkin, P.C., today for help.
What Are the Basics of New York Medicaid Eligibility?
New York Medicaid can provide coverage for eligible individuals who need long-term care, including nursing facility services and certain services that allow people to remain in their homes and communities. Eligibility depends on several factors, with the rules varying based on the applicant’s circumstances and coverage requested. But generally, an adult’s income cannot exceed 133% of the federal poverty level to receive benefits.
For long-term care, financial eligibility is especially important. Applicants may need to establish that their income and resources fall within applicable limits. They may also face transfer-of-assets rules that look at the value of assets the applicant sold or gave away in the recent past.
New York Medicaid eligibility can depend on both financial and care-related requirements. A family should not assume that qualifying for one Medicaid benefit automatically means the person qualifies for every form of long-term care.
Eligibility for Community Based Long Term Care Services
Community based long term care services include many services that a beneficiary may need for several months or years to maintain or improve their health or ability to function. These services may be provided in:
- Assisted living facilities,
- Nursing homes, or
- The patient’s own home.
And these services may include:
- Medical care,
- Services for social needs,
- Rehabilitation services, and
- Housekeeping.
If you want Medicaid to pay for services, you cannot exceed the income limits, and you must have the proper medical and functional needs for them. Specific eligibility requirements can depend on the requested service and the Medicaid program through which you seek them.
Eligibility for Managed Long Term Care
Managed long-term care (MLTC) provides long-term support to people with disabilities or chronic illnesses who want to stay in their homes or communities. MLTC services might include:
- In-home nursing,
- Adult day care,
- In-home therapy, and
- Home health aides.
To qualify for an MLTC, the rules generally require that you meet the income limits and show a need for community-based long-term care services for more than 120 days. You might also need to show that:
- You need limited assistance with moving physically for more than two activities of daily living, or
- You have dementia or Alzheimer’s and need supervision with multiple activities of daily living.
Knowing these rules makes early planning easier, because financial eligibility alone may not complete the process.
What Is the Look-Back Period for Medicaid?
A Medicaid look-back period is an amount of time the state agency providing Medicaid looks at to review your finances and determine your eligibility for services. How far the agency looks back depends on the services you seek.
What Is the 5-Year Look-Back for Medicaid?
If you apply for Medicaid coverage for nursing home care (institutional care), New York generally reviews your finances and any asset transfers you made in the past 60 months, including your:
- Medical bills,
- Gross monthly income,
- Retirement account statements,
- Tax bills,
- Property titles,
- Prepaid funeral documents,
- Rental property income and expenses,
- Bank statements, and
- Other financial records.
Even if you sold or gave your assets to a third party in the recent past, those assets might still count toward Medicaid income limits and bar your access to benefits.
Families asking what the 5-year look-back for Medicaid is should think beyond simply whether the applicant currently owns too much. Medicaid planning can also require examining what happened to assets during the preceding five years.
What Is the Look-Back Period for Other Long-Term Care?
People also ask what is the look-back period for Medicaid when they want care at home rather than in a nursing facility.
New York enacted legislation creating a 30-month look-back at an applicant’s finances for certain CBLT coverage, subject to federal approval. The state has sought federal authorization to implement this rule.
While this limited look-back period may be a relief to many, families should still plan for the state to review the past five years of their finances.
How Can Spending Down and Trusts Help You Become Eligible?
A person whose income exceeds the applicable Medicaid level may still have options.
New York’s Spenddown Program
New York’s Medicaid Excess Income Program, commonly called the “spenddown” or “surplus income” program, can allow certain people to establish eligibility by paying qualifying medical expenses equal to their excess income and having Medicaid cover the rest. New York compares the excess income to a deductible, which can apply to long-term care in the community, including home care and assisted living.
Trusts
Trusts may also help you qualify while saving, but they require careful planning. If you transfer your assets to a trust that is irrevocable and doesn’t make payments to you for your benefit, those trust assets may not be included in your income. A trust should not be created or funded based only on a general understanding that “trusts protect assets.” The details matter.
How to Avoid Medicaid 5-Year Lookback Problems
There is no lawful way to erase the look-back. A better approach is to plan around the rules and protect yourself by:
- Planning before long-term care becomes an emergency,
- Keeping clear financial records,
- Avoiding making large gifts or transferring property without understanding the Medicaid consequences,
- Determining whether an available exception applies, and
- Considering how properly structured estate and Medicaid planning may fit into your family’s goals.
This is where individualized advice from a skilled attorney can make a significant difference.
We Help You Plan Before Long-Term Care Becomes a Crisis
The Law Offices of Andrew M. Lamkin is an award-winning firm that focuses on elder law, estate planning, special needs planning, Medicaid planning, and related matters. We can shoulder the burden of understanding your rights and obligations under state and federal Medicaid rules while helping you or your loved one receive needed care.
The earlier you understand the rules, the more options you may have to protect assets and reduce the risk of costly eligibility delays. Please contact us online or call us today to schedule a consultation.
Legal References Used to Inform This Page
To ensure the accuracy and clarity of this page, we referenced official legal and other resources during the content development process:
- Medicare.gov, Medicaid.
- Medicaid,gov, Medicaid, Children’s Health Insurance Program, & Basic Health Program Eligibility Levels.
- New York State Department of Health, Managed Long Term Care (MLTC).
- New York State Department of Health, About Managed Long Term Care.
- New York City Human Resources Administration, Long Term Care – Home Care Services Program.
- New York State Department of Health, Consumer Guide to Community-Based Long Term Care.
- New York State Department of Health, 30-Month Lookback for Community Based Long Term Care Services.
- New York State Department of Health, GIS 15 MA/07: Policy Change for the Begin Date of the Transfer-of-Assets Look-Back Period.
- New York State Department of Health, Medicaid Excess Income (“Spenddown” or “Surplus Income”) Program.
- New York State Department of Health, Trusts Information.
- Erie County Department of Social Services, Medicaid Long Term Care Eligibility – Nursing Home Division (NHD).
- New York State Profile and Nursing Facilities.
- Medicaid.gov, Institutional Long Term Care.
Andrew Lamkin is principal in the law firm of Andrew M. Lamkin, P.C., where he focuses his practice in the areas of elder law, estate planning and special needs planning, including Wills and Trusts, Medicaid planning, estate administration and residential real estate transactions. He is admitted to practice law in New York and New Jersey.
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