BIG CHANGES COMING TO NEW YORK MEDICAID

New York Medicaid has undergone a number of proposed changes since the COVID-19 pandemic began.  Many of these were part of a broader Medicaid redesign effort aimed at controlling costs and improving care delivery, particularly in long-term care.  One of the most significant areas impacted was Community Medicaid, which includes home care services that allow elderly or disabled individuals to receive care in their own homes instead of in a facility.

            Some of these changes included a 30-month look back period for home care eligibility.  Many New Yorkers are aware that there is a 60-month (5 year) look back for nursing home care but there was no look back for home care.  If the 30-month look back rule is implemented it will mean that Medicaid will examine and penalize applicants for any gifts or uncompensated transfers of assets made within the 30-month period prior to application.

            Implementation of the 30-month look back period and other proposed changes were delayed due to state and federal public health emergency protections during COVID-19.  However, those delays are ending and starting September 1, 2025, one of these changes will officially take effect.

            Currently, in order to qualify for Community Medicaid home care services, an individual must require assistance with at least two Activities of Daily Living (ADLs).  ADLs are basic tasks essential to daily self-care, and they include bathing, dressing, transferring, toileting and feeding. Starting September 1, 2025, the threshold will increase to three ADLs.  This means that most applicants will need to demonstrate a need for hands on help with at least three ADLs to be approved for Medicaid funded home care services.

            There is an exception for individuals with a diagnosed cognitive impairment, such as Alzheimer’s disease or other form of dementia.  For these individuals, the requirement for eligibility will be supervision of at least two ADLs.  Previously, however, these individuals only needed to show a need for supervision of one ADL.  This reduced requirement in the number of ADL recognizes the unique challenges faced by those with cognitive impairments, who may still require significant supervision and support even if they are physically able to perform certain tasks. 

            Tighter Eligibility: Some individuals who currently qualify for Medicaid home care may not meet the new three ADL threshold.  However, Medicaid has indicated that if you are already receiving Medicaid home care services and are enrolled before September 1, 2025, you will be grandfathered in and will retain your eligibility under the previous rules.

            More Caregiver Burden: Families may need to fill in the gaps if Medicaid home care services are reduced or denied due to the new eligibility standards.

            Proactive Planning Needed:  With the 30-month financial look back period for home care still expected to take effect in the future, and stricter eligibility requirements now being implemented, early planning for long-term care is more important than ever.

            If you have questions or concerns regarding the changes to Medicaid, please contact Mavros Panagos Law at 516-447-0455 or email eleni@mavrospanagoslaw.com to schedule a free consultation.

Eleni Mavros Panagos, Esq.

Mavros Panagos Law

200 Broadhollow Road, Suite 207

Melville, New York 11747

516-447-0455

info@mavrospanagoslaw.com