Significant Changes to Medicaid are Starting Next Month
Please view our updated blog post on this topic here.
The New York State 2020 budget is going to create significant changes to the community Medicaid program, starting October 1st. The elderly and disabled who are seeking home-care services are most likely to feel the impact and face challenges as a result. These changes will be the most significant we have witnessed in many years. Here is a summary of the biggest changes to come:
Full review of finances and transfers for a 30 month look back period
For those seeking Medicaid coverage for long-term care services in the community, a comprehensive review of an individual’s finances will be required, going back the last 30 months. The purpose of this “look-back period” is to determine whether the applicant and/or the applicant’s spouse has made any uncompensated transfers (gifts) to anyone during those 30 months. If gifts were made, with few exceptions, there will be a penalty period during which the applicant will not be eligible to receive home care through Medicaid. This will make it more difficult for people to access health care services they need as it will make the application process more complicated and take longer while financial records are gathered and thoroughly reviewed. It is important to note that the effective date of this law was initially slated for October 1, 2020; however, due to the pandemic it has now been changed to January 1, 2021. The significance of this change means that there will be no look-back required on any applications made before January 1st. Any applications made on or after January 1st will be subject to the look-back period; however, the applicant won’t be penalized for any transfers made prior to October 1, 2020.
Stricter eligibility standards for Medicaid’s Consumer Directed Personal Assistance Program (CDPAP) and Personal Care Services (PCS)
The changes also call for most programs that offer long-term care services in the community (at home) to have stricter enrollment criteria. Individuals applying for services like CDPAP and PCS will need to be determined as requiring at least limited assistance with three Activities of Daily Living (ADL). These are activities such as walking, bathing and feeding. One exception to this is those diagnosed with Alzheimer’s, in which case they only need to require assistance with one ADL. This change also begins on the 1st of next month.
New assessors to determine eligibility for CDPAP and PCS
Assessments to determine what level of care individuals need are usually managed by the Local Department of Social Services (LDSS). The changes call for the assessors to be independent and contracted through the Department of Health (DOH). DOH has not established how the assessments are to be performed, nor if the criteria for certain levels of health care services will change. Future assessments will be conducted by an agency of DOH’s choosing, instead of a professional from a local agency who is more likely to be familiar with the unique needs of an individual. The future for Medicaid applicants is unclear; we are yet to find out what they can expect when seeking long-term care services.
These new processes are expected to take longer, especially while the people implementing financial and physical assessments adjust. You and your loved ones could be waiting for a longer period of time to receive long-term health care services that you need, therefore, it is important to start planning early. We strive to help people prepare for future uncertainties and create individualized and comprehensive plans tailored to you and your loved one’s individual needs. We can help you navigate Medicaid forms, or review and revise them to ensure that they are in compliance with the new law, likely to be approved, and to discuss any “red flags” that we may discover (such as potential uncompensated transfers). Witnessing how quickly a “flu-like” illness turned into a global pandemic has demonstrated that you can never be too prepared for a range of possible future scenarios. Please do not hesitate to contact us to schedule a consultation with us. Casey Baxter, our paralegal, has extensive experience in Medicaid application preparations.