New York recently enacted several changes to Medicaid law. These will be going into effect later this year, but it is important for seniors, the disabled, their family members, and the caregiving community to understand the impact of the new provisions and plan accordingly.

Community Long-Term Care Medicaid Look Back

Community long-term care Medicaid covers home care, adult day care, hospice, and assisted living services. Prior to the law changes, there was no financial “look back” period that applied to such Medicaid. Medicaid puts limits on the amount of assets someone can retain in order to qualify. Individuals can transfer assets in certain circumstances allowing them to qualify for Medicaid. For nursing home Medicaid, any nonexempt asset transfers that occur within five years of the application can result in a penalty period– meaning the person would have to wait a period of time before eligibility. Now community long-term care Medicaid also has a look back but for a shorter period than nursing home Medicaid. The look back is 30 months (2.5 years). This goes into effect beginning October 1, 2020. The penalty period for community Medicaid is determined in the same way as it is for nursing home Medicaid. Certain types of transfers are exempt under the law.

For applicants, the change means that they may have a waiting period before receiving home care paid by Medicaid if they have made any asset transfers. In addition, all applicants will be required to gather financial records in support of the application and will likely face some delays in processing of applications.

Changing Eligibility Criteria for Personal Care Services (PCS) and Consumer Directed Personal Assistance Program (CDPAP)

Effective October 1, 2020, in order to be determined eligible for care under PCS or CDPAP, an individual must be assessed to need assistance with more than 3 activities of daily living (ADLs). However, individuals who have an Alzheimer’s or Dementia diagnosis only need to show need with 1 ADL. In addition, for PCS and CDPAP services, the plan of treatment must be proscribed by a “qualified independent physician selected or approved by the Department of Health” (not their treating physician). Only one annual assessment will be required instead of the current two. These changes may make it more difficult for seniors and the disabled to qualify and receive appropriate care.

Managed Long Term Care (MLTC) Assessment Process

The Department of Health is looking to consolidate assessments and approval of CDPAP and PCS (and others) using a Task-Based Assessment Tool in development now and scheduled to go into effect April 1, 2021. Full takeover of the assessment and approval process will be October 1, 2022.

MTLCs are also being phased out. There is a moratorium on new MLTC applications in effect until March 31, 2022. The Department of Health will also assess the need for MLTCs not affiliated with a Medicare managed care plan and formulate a wind-down plan for such MLTCs. There will also be a cap on each operating MLTC’s enrollment.

New York’s changes to Medicaid are an attempt to rein in the costs of Medicaid, but will make it more difficult for many needy individuals to receive care without imperiling their own finances. While many of the proposed changes were not implemented, the financial impact of COVID-19 means that additional revisions may occur in the future. If you or a loved one may need community or nursing home Medicaid, contact me to discuss your long-term care planning options.