The anticipated 30-month Medicaid lookback period for New York community-based long-term care (CBLTC) services is now delayed until at least 2025. This postponement provides additional time for individuals to prepare for future changes. Presently, there is no lookback or transfer penalty for Medicaid applications covering managed long-term care (MLTC), home care services, or the Assisted Living Program (ALP).
The Medicaid lookback period, introduced in the April 2020 New York State budget, will apply to new applications for long-term care services once it takes effect. However, its implementation is delayed until at least 2025 due to federal approval, procedural development, and staff training requirements. When enacted, the Medicaid look-back period in NY will impact eligibility for CBLTC services, including MLTC and the ALP. Still, it will exclude primary and acute care or waiver programs such as Traumatic Brain Injury (TBI), Nursing Home Transition and Diversion (NHTD), and the Office for People With Developmental Disabilities (OPWDD). Understanding these rules and planning ahead can protect your assets and ensure access to necessary care. Legal guidance from the Law Office of Andrew M. Lamkin, P.C. can help you prepare effectively and avoid complications as these changes unfold.
What Is Medicaid?
Medicaid is a health insurance program funded by the government and designed to provide healthcare coverage to individuals with limited financial resources. It is funded jointly by the federal government and states covers many healthcare services, including long-term care.
In New York, Medicaid pays for nursing home care, non-medical services, and support to help frail seniors live at home or in the community. Non-medical services include personal care, home health care, and adult day health care.
What Is the Medicaid Lookback?
The Medicaid lookback is a period when Medicaid reviews your financial records to see if you have given away assets to qualify for Medicaid. If you have given away assets during the lookback period, you may be ineligible for Medicaid for some time, depending on the value of the assets you gave away.
The lookback is in place to prevent people from giving away their assets to meet Medicaid’s asset limit. This limit is the amount of money and property an applicant can have and still qualify for Medicaid.
What Types of Assets Are Subject to the Lookback Period?
The Medicaid lookback period applies to all types of assets, including cash, investments, real estate, and personal property. However, there are some exceptions to the lookback period. These exceptions include:
- Transfers to a spouse or minor child. This means you can give your spouse or minor children assets without paying a penalty.
- Transfers to a qualified disability trust. A qualified disability trust is a special type of trust that can be used to protect the assets of a person with a disability.
- Transfers to pay for medical expenses. You can transfer assets to pay for your, your spouse’s, or your minor children’s medical expenses without paying a penalty.
- Transfers to certain types of trusts, such as pooled trusts. A pooled trust is a special type of trust that combines the assets of multiple people with disabilities.
- Transfers made more than 30 months before you applied for Medicaid. This means that you can give away assets more than 30 months before applying for Medicaid without paying a penalty.
It is important to note that the exceptions to the Medicaid lookback period can be complex. If you are considering making any transfers of assets, it is essential to consult with an attorney experienced in Medicaid planning.
What Are Community-Based Long-Term Care Services?
Community-based long-term care services (CBLTC services) help people with disabilities and older adults live independently in their homes and communities. These services can include:
- Personal care services involving help with activities of daily living (ADLs), such as bathing, dressing, and using the toilet;
- Home health care services such as skilled nursing care, physical therapy, and other medical services in the home;
- Adult day health care, including supervision and activities for adults who need care during the day;
- Assisted living services, including housing, meals, and personal care services in a residential setting; and
- Consumer-directed personal assistance services that allow you to choose and manage your own caregivers.
New York State’s new Medicaid lookback period for CBLTC services applies to those not living in a nursing home or other institution.
How Will New York’s Medicaid Lookback Period for Community-Based Long-Term Care Work?
Although initially set for earlier implementation, New York’s Medicaid lookback period for CBLTC services is now delayed until at least 2025. The community coverage w/CBLTC will examine financial transfers made within 30 months of a Medicaid application for services like MLTC and the ALP. While specific regulations are still under development, the following details offer insight into how the lookback will function and its potential impact.
What the Lookback Period Covers
When the community Medicaid in NY lookback begins, applicants will be required to submit detailed financial records for the prior 30 months. Transfers made during this time, such as gifts or asset transfers without fair compensation, may trigger a penalty period. This penalty delays Medicaid eligibility and is calculated based on the value of the uncompensated transfer divided by the regional Medicaid penalty rate.
Examples of How Penalties May Apply
Consider these scenarios to understand potential outcomes under the potential community Medicaid look-back period rules:
- Scenario 1. If you gift $10,000 to a relative within the lookback period, Medicaid may impose a penalty of $500 per month for 20 months.
- Scenario 2. Selling a home for less than market value or transferring it to a family member could result in a penalty proportional to the difference between the sale price and market value.
- Scenario 3. Depositing $50,000 into a Medicaid trust within the lookback period may not incur a penalty if the funds are used solely for the applicant’s needs.
These are just a few scenarios to consider. There may be others that apply to your specific situation.
Important Considerations for Future Planning
While details are still evolving, the lookback will not apply to waiver programs such as TBI, NHTDW, OPWDD, or Medicaid for primary and acute care. The New York Department of Health (DOH) has also acknowledged the need to revise “undue hardship” exceptions. It may allow pooled income trusts with documentation showing funds were spent on the applicant’s needs.
Legal assistance can help you plan effectively, minimize penalties, and meet eligibility requirements when these changes take effect. Staying informed and proactive can make a significant difference in preparing for Medicaid’s evolving policies.
What to Do If You’re Thinking About Applying for Medicaid
If you’re considering applying for Medicaid, it’s important to talk to an attorney focusing on Medicaid planning. A lawyer can help you understand the new lookback period and how it will affect you. They can also help you protect your assets and qualify for Medicaid.
With the new 30-month Medicaid lookback period for community-based long-term care services approaching, staying informed is essential. This change presents challenges and opportunities for people planning their long-term care needs.
The implementation of the lookback period has been delayed several times in the past, so it could be delayed again. However, it’s always best to be prepared, so it’s a good idea to start planning now.
How We Can Help You Plan for Long-Term Care
We have comprehensive knowledge of New York’s Medicaid laws at the Law Office of Andrew M. Lamkin, P.C. We can help you create a plan to protect your assets and income for your family, both now and in the future.
We focus exclusively on New York estate planning, estate administration, supplemental needs planning, residential real estate transactions, and elder law. This allows us to provide you and your family with a comprehensive approach to estate planning and asset protection.
When you work with us, you can expect:
- A personalized consultation—we will carefully listen to your concerns and goals and create a plan tailored to your needs;
- Clear explanations—we will explain the asset protection concepts we use in plain language so you understand precisely how they work to achieve your goals;
- Personal attention—we will personally work on every aspect of your case, from start to finish; and
- Collaboration—we will work with your other advisors, such as your accountant and financial planner, to create a complete estate plan.
Our firm understands that planning for long-term care can be a daunting task. But it doesn’t have to be. We are here to help you every step of the way. Contact us for a free consultation.
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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