NYS Community Medicaid Eligibility Will Soon be a Greater Challenge

Be Informed and Take Action Now!

While almost everyone was focused on the coronavirus pandemic, the New York State Legislature, flying under the radar, took the opportunity to include new Medicaid rules in the budget.  The changes will make it more difficult for New Yorkers to access Community Medicaid services.

Once these changes take effect, Community Medicaid applicants will face greater challenges in obtaining services, including Home Care.  As a result, New Yorkers who fail to plan ahead may wind up spending tens of thousands of dollars out-of-pocket before they can access Medicaid benefits.  We are urging our clients, and any senior or person whose long-term care is a concern, to act before the changes in eligibility rules take effect. 

The changes that will have the largest impact are currently scheduled to become effective on March 31, 2024.   The window for seniors and disabled persons to put plans in place under the current, more generous rules regarding this vital government program has been extended several times, but that is no reason to delay.  The process of applying for Medicaid is complicated and time-consuming.  Acting quickly will give you the best chance possible of achieving the best outcome for you without undue stress and anxiety.  There is still a lot of discussion surrounding the implementation of these changes; contact our firm for the latest status.

Among the changes that will adversely affect seniors and disabled persons, these are the most significant:

 1. The New 30-Month “Look Back”

In New York, it is currently possible to access Community Medicaid quickly, but that will be changing.  Formerly there was no “look back” period when applying for Community Medicaid services.  However, the new rules will, once implemented, count uncompensated gifts and transfers starting October 1, 2020.  From that point on, new applicants will need to provide bank statements and financial information for a period of 30 months (2 1/2 years) when applying for Community Medicaid benefits.  Our article "Changes to Community Medicaid Begin Soon" has more details.

As with Nursing Home Medicaid, the Community Medicaid application will require disclosure of any gifts or transfers that have been made without consideration (e.g., monetary gifts to children or transfers to a trust) during the “look back” period.  If so, the applicant will be subject to a “penalty period” during which he or she will not be eligible for Community Medicaid benefits.  Those who need Home Care, for example, could be forced to pay out-of-pocket for up to 30 months, which could wipe out their savings.

2. More ADLs will be required to qualify for services

Personal care services for Medicaid recipients will also have more restrictive rules, and services will not be as widely available as they are currently.  In order to qualify for personal care services by enrollment with a Managed Long-Term Care agency (“MLTC”) or under the Consumer Directed Personal Assistance Program (“CDPAP”), the new rules will require that an applicant need assistance with three or more Activities of Daily Living (“ADLs”) where before, needing assistance with two ADLs made a person eligible.

There is an exception for people with a diagnosis of Alzheimer’s Disease or dementia, in which case a person needing assistance with two or more ADLs is eligible.  So, for example, if your Mom does not have dementia, but needs assistance with two ADLs such as getting out of bed and dressing, she will no longer be eligible for Medicaid personal care services.  She will have to pay for the help she needs with her own funds.

3.  A prescription from an independent physician will be required

Personal care services (whether MLTC or CDPAP) will be required to be prescribed by an independent physician selected or approved by the Department of Health.  This rule will likely cause delays because the independent physician will not be familiar with the applicant, and may have little or no experience or medical knowledge regarding the applicant’s specific health issues or diagnosis.

The above changes, and others, are the largest changes to New York’s Medicaid program in many years.  New York Medicaid will still be one of the most generous programs in the country, but once these changes take effect, it will be harder for people to access Medicaid services.

The new rules are also likely to result in long delays on submitted applications.  The rules will create far more work for Medicaid caseworkers.  Some ambiguity in the new regulations will lead to confusion and different ways of applying them.  It will take time to create and institute standard practices.  Will the various Medicaid offices increase their staffs to be able to give prompt attention to these more complicated applications?   That’s doubtful, in our opinion.  

Without being alarmist, now is the time to take action.  Seniors need to learn how these changes could affect them, and decide on the best course of action.  Creating a plan that incorporates long-term care planning with an estate plan would be wise.  If someone already has an estate plan, now would be a good time to review and update it.

The sooner you act, the greater your ability to protect your savings and property against the ruinous costs of long-term care.  

Helping clients create and execute effective long-term care plans has always been a key focus for Lamson & Cutner.  We have years of experience with these situations, and have had tremendous success in helping clients protect their life’s savings from being wiped out by long-term care expenses.  

Since the beginning of the coronavirus pandemic, we have been having meetings, consultations, Will signings and more by video conference.  Even our most senior clients have found video conferencing easy and effective.  For those who don’t have computers, consultations by telephone or conference call are simple and effective.

If you wish to learn more, please look at our website, www.cutner.com, or call us at (212) 447-8690 to schedule a consultation about your personal situation.  We are also planning to conduct educational online programs about the changes in Medicaid’s rules.  Information will be posted on our website, and you can also contact us anytime for further details. 

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