As the nation’s most common insurance provider, Medicaid provides free or low cost medical services to more than 63 million Americans, including low-income adults, children, pregnant women, elders and people with various disabilities. Aside from medical services, Medicaid also supports 65% of the 1.3 million elders currently living in nursing homes and assisted-living facilities. As the nation collectively faces the most severe pandemic in modern history, it’s important to stay up-to-date on how the current climate affects this vastly popular public program.
One of the biggest changes being made to the Medicaid application process is the addition of what is known as a “lookback” period of 30 months for home care services, private duty nursing services, personal care services, and assisted living program services starting October 1st, 2020. A lookback period will make it so that any transfer of assets, that isn’t an “exempt” transfer, in the 30 months before an application is submitted will cause the applicant to be denied coverage for a “penalty” period. Although the state has yet to release the full details regarding the updates to the Medicaid application process, if they use the same penalty period as the one currently used for admission to nursing homes, coverage can be denied for one month for every $12,844 transferred. Again, although there is little available information regarding the matter, it’s a good idea to begin long-term care planning keeping in mind the new requirements.
What Transfers Are Exempt From The Lookback Period?
The usual exemptions still apply - transfers to your spouse, transfers by an individual under 65 to a supplemental needs trust, transfers to a disabled child. See exemptions to a transfer penalty for nursing home eligibility here. As with the information regarding the changes to the lookback period, we expect more details to surface in the coming months.
What Happens Now?
There’s no denying that the healthcare system, particularly in New York, is running at full capacity if not over-capacity at this point. Hospitals are full of patients sick with the novel coronavirus and other illnesses and nurses are working around the clock to make sure that as many people receive the care that they need and eventually are able to check out in stable condition. That being said, an international pandemic does not put a pause on people applying for Medicaid home care, and with millions of people facing layoffs and thus, financial instability, we can surely expect long delays in the Medicaid application process as a record number of people find themselves in a position where applying is a necessity. As it currently stands, Medicaid agencies must comply with time limits for reviewing and approving applications - generally 45 days or 90 if a disability determination is required. As expected, however, even now applications often exceed these limits which puts strain on local districts and causes more delays to the already delayed and overworked healthcare system. That being the case, with the new lookback period coming into play later this year, if you need the assistance of an aid in your house or know someone who does, the time to start planning is now.
Although times are certainly tough, it’s important to recognize that planning for long-term care, especially in the current climate, is of paramount importance to make sure that you or your loved ones receive the care that you need when you need it the most. If you or a loved one are looking to apply for Medicaid in the near future, we highly recommend you consult with a licensed Medicaid planning attorney who can help ensure your eligibility for medical coverage and/or homecare in your later years.