Eligibility Changes Coming to New York Medicaid Home Care
On October 1, 2020, significant changes will come to New York’s Medicaid home care services program. The New York Legislature has enacted new restrictions on eligibility for Medicaid home care and other community-based long-term care services.
Prior to the enactment of this legislation, there was no lookback period for gifts of assets that an applicant made prior to the month of their Medicaid application and, therefore, there was no “penalty period” in which Medicaid would not pay for services because of these gifts. A Medicaid applicant could make a gift in one month and be eligible for Medicaid home care services the next month. This differed from Medicaid nursing home care which has a five-year lookback period and a penalty period for which applicants are ineligible for Medicaid if any gifts were made during those previous five years. Under the new law, there will now be a 30-month lookback period for home care applications made on or after October 1, 2020 with a period of ineligibility if the applicant made gifts during those past 30 months.
The legislation also changes the eligibility criteria and assessment procedures for home care services. Prior to this legislation, an applicant qualified for home care services if the applicant needed any assistance with “Activities of Daily Living” (ADL) for 120 or more days. If the applicant did not need ADL assistance, he or she could still get housekeeping assistance for up to eight hours a week for instrumental ADLs, such as housekeeping activities, laundry and shopping. After October 1, 2020, the new criteria will be more stringent as housekeeping services will no longer be a provided Medicaid personal care service. To be eligible for home care services, the applicant will need either assistance with more than one ADL if the applicant has dementia or an Alzheimer's diagnosis or assistance with two or more ADLs if the applicant needs limited assistance with physical maneuvering. In addition, the assessment of the applicant’s needs will be conducted by an independent doctor selected and approved by the New York Department of Health rather than the applicant’s own personal physician.
Due to these changes, as well as other potential changes that are still uncertain, it is recommended that anyone who may need Medicaid home care benefits apply prior to October 1, 2020.