If you or a loved one are in need of assistance with daily living and are considering applying for Medicaid home care in New York, the latest update to the 30-month lookback rule is something you can’t afford to ignore. While the lookback period was originally set to take effect in 2021 and has faced multiple delays, it is now expected to be implemented in March 2025 or possibly could delay again. This means that for the time being, applicants can still qualify for Medicaid home care without the added hurdle of providing financial records for the past 30 months. But once this rule is in place, it will drastically impact eligibility, making now the time to act.
What’s Happening with the Medicaid Lookback Rule?
New York has long had a five-year lookback period for Medicaid nursing home care, requiring applicants to disclose financial transactions from the past 60 months to determine eligibility. In 2020, a new law introduced a 30-month lookback for community-based long-term care (i.e., home care and assisted living services covered by Medicaid).
This rule was supposed to take effect in October 2020, but due to the COVID-19 pandemic and subsequent federal funding requirements, the state has repeatedly postponed its implementation. Most recently, the New York State Department of Health has indicated that the rule will not be enforced until at least March 2025, offering a limited-time window for individuals to apply for Medicaid home care under the existing, more lenient rules.
Why This Delay Matters
Once the 30-month lookback goes into effect, individuals applying for Medicaid home care will need to disclose all financial transactions dating back 2.5 years. If they have transferred assets within that time frame, they may face penalty periods that delay their ability to receive Medicaid-covered care.
However, individuals who apply for Medicaid before the new rule takes effect will be grandfathered in under the current rules (30-day lookback period).
Understanding the Lookback and Penalty Periods
Medicaid’s look back rule is designed to prevent individuals from transferring assets to qualify for benefits they would otherwise be ineligible for. Here’s how it works:
- Medicaid will examine financial records for any uncompensated transfers (gifts, asset transfers to family members, etc.).
- If any such transfers are found within the lookback period, Medicaid applies a penalty period during which the applicant is ineligible for benefits.
- The length of the penalty is determined by dividing the amount transferred by Medicaid’s regional monthly rate for nursing home care (which varies by county).
- Since New York Medicaid home care currently has a 30-day lookback period, applicants today can transfer assets within the month to avoid a larger penalty. Ask us how!
Who Will Be Affected by the 30-Month Lookback?
When implemented, the 30-month lookback will apply to individuals seeking the following Medicaid services:
- Personal Care Services (PCS)
- Consumer Directed Personal Assistance Program (CDPAP)
- Assisted Living Program (ALP)
This will not impact individuals who are already enrolled in Medicaid home care services before the rule takes effect. Therefore, applying now is the best way to ensure continued eligibility under current rules.
Key Steps to Take Before the Rule is Implemented
1. File Your Medicaid Application Now
If you or a loved one need home care or assisted living services soon, don’t wait. Applying before the lookback is enforced allows you to qualify under today’s rules, avoiding the risk of penalties and delays.
2. Review Your Financial History
Even though the lookback rule is not yet in place, it’s smart to evaluate past transactions. If you’ve transferred assets since October 1, 2020, they could be scrutinized once the rule takes effect. Working with an experienced Medicaid planning attorney can help you develop strategies to protect your eligibility.
3. Consider an Irrevocable Asset Protection Trust (iPug®)
For those who need long-term Medicaid planning, an Irrevocable Pure Grantor Trust® (iPug®) can be a valuable tool. This allows individuals to transfer assets into a trust while maintaining control over them.. However, these trusts need to be set up well in advance, making early planning crucial.
4. Take Advantage of Legal Exemptions
Certain asset transfers do not count against Medicaid eligibility, such as:
- Certain transfers to a spouse
- Certain transfers to a disabled child or a trust for their benefit
- Certain transfers of a home to a child who has been a caregiver for at least two years
- Certain retirement accounts.
Understanding these exemptions can help families legally protect assets while ensuring access to necessary care.
What Happens After the Lookback Rule is Implemented?
Once the 30-month lookback is enforced, Medicaid applicants will need to:
- Provide detailed financial records for the past 2.5 years.
- Justify any large asset transfers made after October 1, 2020.
- Potentially face penalty periods delaying their access to care.
This will make last-minute Medicaid planning far more difficult. Individuals who fail to prepare in advance could find themselves in a situation where they must spend down assets or wait months before receiving home care assistance.
Why You Need a Medicaid Planning Attorney
Medicaid eligibility rules are complex, and the upcoming changes will make navigating the system even more challenging. A Medicaid planning attorney can:
- Help you apply before the lookback is enforced to maximize benefits.
- Develop asset protection strategies to minimize penalties.
- Identify legal exemptions that allow you to transfer assets without impacting eligibility.
At Estate Planning Law Center, we help families secure Medicaid benefits while protecting their financial future. If you or a loved one are considering Medicaid home care, now is the time to act.
Book yourself onto a workshop today: The Clock is Ticking
The delay in New York’s 30-month Medicaid lookback is a limited-time opportunity for families to take advantage of more lenient eligibility rules. Once the lookback is enforced, Medicaid planning will become far more complex, with increased scrutiny of financial records and potential penalties for asset transfers.
Register for a seat on an upcoming workshop with EPLC.
If you think you or a loved one may need Medicaid home care in the near future, don’t wait. Applying before the rule takes effect ensures you receive the care you need without unnecessary delays.
In need of assistance with activities of daily living and need help securing Medicaid benefits before the rules change? Our experienced team is here to guide you through the process and protect your access to long-term care. Reach out today!
