The Department of Social Services ”looks back” at financial transactions made by the applicant or his/her spouse and may institute a so-called “penalty period” on non-exempt transferred assets which creates a waiting period on benefits which varies depending on the situation. For example, the regional rate for the Northern Metropolitan area (Westchester, Putnam, Rockland, Orange and Dutchess Counties) for the year 2020 is $12,805.00 per month. An individual Medicaid recipient residing in the community in 2020 can retain income of $875 per month plus an unearned income credit of $20; an individual in an institution such as a nursing home is restricted to a personal needs allowance of $50 per month.

If you need legal advice concerning this or any other topic please contact our offices to schedule a consultation with one of our attorneys at 914-684-2100 or 212-490-2020. Special Needs Planning, by Michael S. Kutzin and Allison Landwehr, Medicaid Eligibility Plan and Applications, The definition was extended in 2013 to include people in the Managed Long Term Care (MLTC) Program, Medicare And Medigap Insurance Policies: Maximizing The Benefits, Breaking News: New York will apply new Medicaid budgeting rules for home care, Glossary of Elder Law Estate Planning Terms, IRS Announces Higher Estate and Gift Tax Limits for 2020, Medicare Prescription Drug Benefit What Does It Mean To You, Medicaid Application Services Are NOT Medicaid Planning, The Jimmo Case and the Medicare Improvement Standard, How Medicare Recipients Can Prepare for the Termination of Certain Supplemental Medicare Policies (Medigap), Changes in Fair Hearing Rights for Medicaid Managed Long Term Care and Managed Care Members Effective May 2018, Guardianship for Incapacitated People in New York Under Article 81, Ten Biggest Mistakes You Can Make In Your Estate Plan, Health Care Decision Making for Incapacitated People Who Have Not Signed a Health Care Proxy, Elder Law Estate Planning Issues for Women, Public Charge Rule Poses Population Health Threat, H+H Leaders Say, Speeding You Through the New York State Probate Process, Estate Planning for Singles and Couples Without Children, Recognizing the Signs of Financial Elder Abuse, Detering Exploitation of a Power of Attorney, Justice in Aging Report Indicates that CMS is Continuing to Roll Back Nursing Home Protections, Federal Law Establishing Security Freezes and Fraud Alert Protection to Take Effect September 21, 2018, Social Security Administration Issues Warning Regarding Phone Scams, CMS Reverses Obama Policy on Nursing Home Quality Enforcement, Nursing Home Residents’ Rights and the LGBT Community, You Can Leave Home and Still Receive Medicare-Covered Home Care, The Irrevocable Life Insurance Trust (ILIT), Medicaid Coverage of Home Care in New York, Advanced Directives: Health Care Proxies, Living Wills and Powers of Attorney, “Spousal Impoverishment” Budgeting for Managed Long Term Care, Frequently Asked Questions Concerning Living Wills and Health Care Proxies, New York Expands Due Process Rights for Medicaid MLTC Recipients, Transition of Medicaid Nursing Home residents into Managed Care, The Estate Tax Is Back, but with Some Twists—and Opportunities, Navigating your Child’s Special Education Program: A Guide for Parents and Guardians. [ii] See id. From his/her own income the nursing home resident retains a personal needs allowance ($50 per month) and must spend down his/her remaining income on medical care. Penalty periods expire five years after the transfer or begin to run when the applicant/recipient is in a nursing home, has exhausted all non-exempt resources, and is “otherwise eligible” for Medicaid. [i]  The other exempt transfers that should apply under Social Services Law § 366 (5)(e)(3)(i), (ii) and (iii) include the purchase of an annuity, the purchase of a life estate, the purchase of a promissory note loan or mortgage. With regard to nursing home care, New York state will continue to impose a five-year lookback period to qualify for nursing home Medicaid benefits, the new rules mentioned above only apply to Medicaid benefits covered in the home.

Be sure to review whether you need to purchase Medicare Part D to help pay for drugs. Medicaid's Asset Transfer Rules In  order  to be eligible for Medicaid, you cannot have recently transferred assets. Like the not-for-profit trust, all monthly income above $895 must be deposited in the trust and only bills directly benefiting the Medicaid recipient can be paid by the trust. Your comment has not yet been posted. For example, in New York State transfers/gifts will not disqualify you from receiving community-based care including home health care, but will cause a disqualification period for nursing home care.
Transferring assets to certain recipients will not trigger a period of Medicaid ineligibility. A person applying for Medicaid must disclose all financial transactions for the previous five years. The Home: Medicaid Rules. In early October 2020, because of the pandemic, the Trump administration renewed the Public Health Emergency for an additional ninety (90) days effective October 23, 2020.

Applicants who transferred assets during this new lookback period will face a period of ineligibility when Medicaid will not be available to them. ADLs include tasks like bathing, dressing, eating, and toileting.
Although the above mentioned programs are not subject to lookback or transfer penalties, there are not exceptions on asset transfers as they pertain to long term hospital care or assisted living facility care paid by Medicaid.

This brief window of opportunity benefits people that have chronic conditions and need home care benefits now. Seniors and the Disabled Get a Needed Reprieve from the Imposition of... Doctors of Distinction – Fairfield and Westchester, Pfizer says its Covid-19 vaccine is more than 90% effective. For those seniors who have income and / or asset(s) greater than the allowable amounts, Medicaid planning can be invaluable . The attraction for Medicare subscribers to take Part C is that you do not have to pay for Medigap insurance. There are also important exceptions to the asset transfer rules as well as legal strategies including certain trusts that can help preserve assets while ensuring eligibility. In that scenario, you will have to contend with the new lookback period if and when you eventually do apply for Medicaid. If the transfer was to the spouse, the spouse is prohibited from transferring the resource without creating a penalty period. This is an excellent strategy, as long as the Medicaid rules are followed. This co-payment for nursing home care can exceed $10,000 if you do not choose the correct Medigap policy that covers the co-payment for nursing home stays. For those applicants, the old rules still apply, such that if you make asset transfers such as moving a property into a Trust, it won’t be counted against you, but only if you apply for Medicaid prior to April 1, 2021.

Email address will not be displayed with the comment.). L. § 366 (5)(e)(4)(i). is a member of Enea, Scanlan and Sirignano, LLP of White Plains and Somers, New York. For many families, paying for a loved one’s extended stay in a nursing home would be difficult without the help of Medicaid. Under Federal Law, Medicaid recipients may join a not-for-profit pooled income trust to protect monthly income above $895 so it can be used to pay the Medicaid recipient’s bills. Medicare, however, is far from perfect; it is in fact a safety net with many holes. Under the new rules, all gifts and other transfers made within five years of applying are treated the same: as if they were made on the day the application was filed.

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