Medicaid Eligibility After October 1st and new Look Back provision

Important Dates to Note

Changes in regards to Medicaid Homecare eligibility were intended to start taking place on October 1st 2020, however, these changes have been delayed and are stated to take place on January 1st, 2021. These changes pertain to massive cuts in Medicaid, which have a direct impact on long term care by decreasing the extent of money allocated towards such medical care. In the face of the recent Covid-19 pandemic NYS aims to provide an additional $6.2 billion in extra federal funding for Medicaid funding. With the current pandemic it has been decided that Medicaid cuts cannot take place prior to the end of the healthcare crisis, which is known as Maintenance of Effort (MOE). In result of MOE, lookback will not begin till the further date of January 1st, 2021meaning that the homecare changes will not be starting in October of 2020. Governor Cuomo lobbied in support of ending the MOE requirements for the future stimulus bills of New York State.

Medicaid Lookback 2020-2021

What is a Medicaid lookback?

A Medicaid Lookback is imperative in relation to Financial Eligibility for Medicaid. This means that if a lookback is required for a specific service, then the medicaid applicant is required to present all financial records pertaining to the applicant and their spouse during the lookback period. The typical lookback period for nursing homes is estimated to be around 5 years. The Human Resource Administration (HRA) is responsible for reviewing the lookback documents and checking the transfer of assets, especially in identifying transfers for less than the fair market value by the applicant or spouse during this period. Based on current NY State laws, nursing homes are required to do a lookback to admit applicants for care. The lookback will  be required for people who are in the Medicaid Buy-In for Working People with Disabilities. Applicants who have an income that is below the income bracket of $895 as a single individual or $1304 for a couple will not be required to partake in the lookback process.

Who will qualify for Medicaid Personal Care?

In order to enroll in personal care New York has established minimum requirements for new applicants. Individuals must require “limited assistance with physical maneuvering” in three specific daily activities. Currently, individuals with dementia only require assistants in two activities due to their impairment. There has been a push to enhance the accessibility to supervision instead of physical assistance should qualify, even if their specific impairment is not dementia. Such change is assumed to go into effect on January 1st, 2021, which will allow individuals with developmental disabilities, brain injuries, impaired vision, and other health conditions to obtain supervision with just two of the activities associated with daily living due to their state of health.

What is the Housekeeping Program?

This program applies to individuals that have impairments in regards to the specific daily activities and therefore require assistance with household chores. These chores pertain to cleaning, grocery shopping, completing laundry, as well as numerous other tasks. Level 1 Personal Care refers to individuals who do not require assistance with the daily activities stated within the Medicaid Personal Care requirements, however do need aid in terms of completing household chores due to their personal state of health. Due to the extent to their conditions they are ineligible for Managed Long Term Care (MLTC) but could still apply for housekeeping services through the aid of the Medicaid office. However, due to current changes new applicants are ineligible to apply for housekeeping services. In other words, individuals who are not presently receiving these services must wait until they are unable to perform the tasks on their own due to injury and then will require assistance with activities of daily living.

How can individuals best prepare for all of these changes?

New rules and regulations can be extremely difficult to completely understand and the information may seem overwhelming when facing new changes alone. In order to alleviate these concerns and to be best informed on the current changes, one should reach out to an esteemed attorney who will walk clients through the process and explain all of the changes. Learning the new laws is just one aspect, as it is imperative to understand how these new regulations will directly impact one’s life. An experienced attorney who has superior knowledge on Medicaid Healthcare Eligibility will be able to further explain exactly how each of the laws will have an influence on the client and what they can do in order to best prepare for these changes. For Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to best prepare for Medicaid eligibility changes after October 1st and the new Lookback provision.