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NY Community Medicaid Look Back Is Still on Hold

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Community MedicaidThis article addresses a very important issue for families with family members that require in-home care and would like to shelter funds from oppressive long-term care costs.

Elder law attorneys help clients address matters that are of interest to seniors, and long-term care is at the top of the list. Most older people will need long-term care eventually, and more than half of them will require assistance that is provided by a professional caregiver.

Medicare does not pay for the custodial care that you would receive in a nursing home, and it does not cover in-home care. This is a pretty big deal because the average monthly charge for a private room in a Staten Island nursing home was just under $13,000 last year.

The average length of stay is 12 months, but 52 percent of people that receive paid care require the assistance for more than a year, and 13 percent incur the bills for more than five years.

Genworth Financial has provided the average cost figures, and they found that the average monthly charge for an in-home health aide in Staten Island last year was $4957.

Medicaid and Community Medicaid

Medicaid will cover long-term care if you can gain eligibility, and there is a Community Medicaid program that will pay for in-home care. Since Medicaid is only available to people with limited resources, there is a $15,900 asset limit in New York in 2021.

There has always been a five-year look back period for Medicaid eligibility. It is natural to consider gift giving if and when you find out that you need long-term care. You would essentially be giving your loved ones their inheritances in advance.

This would be an overt example of “playing the system,” so there is a rule in place to prevent reactive divestitures. There is a five-year look back period, so you cannot qualify for Medicaid if you give away assets within five years of your application date.

Your eligibility would be delayed by a period of time that is based on the cost of nursing home care in New York.

For example, if the cost is $13,000 a month, and you give away $130,000, you transferred enough to pay for 10 months of nursing home care. As a result, your eligibility would be delayed by 10 months.

Look Back Period for Community Medicaid

Traditionally, there has not been a look back period for Community Medicaid in New York. You could give assets to your loved ones and gain eligibility without being penalized.

However, a significant change was implemented in 2020, and a 30-month look back was supposed go into effect on October 1 of that year. However, the COVID-19 pandemic came along, and the Families First Cares Act was enacted on the federal level.

Under a provision in the measure, states cannot restrict Medicaid eligibility during the pandemic. This was interpreted to apply to the pending implementation of the look back period for Community Medicaid in New York, and the protections have been extended.

The date of the look back implementation has been pushed back a few times, and Western New York Law Center has been providing updated information about the situation. They have learned that the implementation of the look back will be delayed until April 22nd of next year at the earliest.

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Neil O'Reilly
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About Neil O'Reilly

Cornelius (“Neil”) J. O’Reilly is an attorney whose practice is focused in the areas of Estate Planning, Estate Administration, and Business Succession Planning. His main goal is to demystify Estate Planning for his clients so they can gain peace of mind knowing that they have provided for their families by passing along their hard-earned wealth and by minimizing the stress they will experience if the client becomes incapacitated or dies. He has created the firm with the belief that an estate plan should be driven by the unique needs and desires of each unique client. That’s why there are no “cookie cutter” plans or canned solutions offered to any client. Instead, Neil helps clients identify their goals and then builds estate plans based on those goals.