In the midst of the worst health crisis to hit our country in over a century, on April 2, 2020, New York State legislators and the Governor passed a budget which called for major restrictions to the Medicaid Program to begin on October 1, 2020. The change that will impact families the most is the 2 and ½ year lookback for Medicaid Home Care Applications where there had been previously no lookback. Structural changes to home care assessment, care needs standards and case processing were also outlined in the budget.
Sudden onset of an illness or physical ailment is a destabilizing event for any family. The path to long term care may include stops at hospitals, rehabilitation facilities and nursing homes. Every step of the way is paved with health insurance questions. Once long-term care is contemplated then Medicaid becomes an integral resource for families to pay for services. Asset transfer barriers were not in place for Medicaid Home Care applicants up until now. An ill or disabled individual without a spouse could transfer excess assets over $15,750 to another person or Trust without a penalty. Now, local Department of Social Services (DSS) Offices handling Medicaid Applications will require 2 and ½ years of financial and bank statements for review. If DSS finds non-exempt transfers of assets they have the right to place a penalty on the amount transferred which would create a penalty period. This penalty period would most likely be calculated by dividing the amount transferred by the average monthly rate of home care for that region of New York State. The calculation would yield the number of months that the applicant is ineligible for services and would have to pay privately.
The cost of living in New York with state taxes, high property taxes, and elevated price points for many goods and services requires sufficient cash flow and savings. Unexpected costs can devastate a family’s finances. Long Term care is extremely expensive and by penalizing transfers of assets within 2 and a half years of the application there will be increased private pay burdens on families resulting in net losses of thousands of dollars.
The changes to the Home Care Medicaid Application Process are not limited to lookbacks and asset transfer penalties. Medicaid includes different home care options and waivered services. Eligibility before the budget changes allowed for fewer Activities of Daily Living (ADL) limitations. Now 3 ADL’s requiring assistance per applicant will be required. New assessment tools as well as an independent physician and independent assessor will also be added to the applicant’s Medicaid Home Care process.
In the short term, all of these changes will require implementation time and create delays. Medicaid applicants will be waiting longer, paying more money out-of-pocket and navigating a more confusing system.
To stay on top of all of the Medicaid changes, please call the professionals at Sloan and Feller today.