I know we have been discussing this for years, but unfortunately, there are now clues that point to the New York State Community Medicaid 2.5-year financial lookback/transfer penalty actually taking place as soon as late 2025.
You may have read in my previous blog about the new Community Medicaid care qualifications. To qualify for Community Medicaid, you will need physical assistance with at least 3 activities of daily living (ADLs). If you have a dementia diagnosis, you need to require at least cueing and supervision with at least 2 ADLs. (Community Medicaid Care Changes)
Financial 2.5-Year (30-Month) Lookback/Transfer Penalty for Community Medicaid – What Does It Mean?
- When financially applying for Community Medicaid, the Department of Social Services (DSS) will look back 30 months to see if there were any transfers made (they may deem these transfers were made in order for you to be eligible for Medicaid).
- Even if no transfers were made, the work required for DSS to conduct the lookback will likely elongate the process of applying for Medicaid.
- Those applying will be required to provide more financial documentation because they are looking back 30 months.
Community Medicaid currently has no lookback or transfer penalty.
The Clues That the Lookback Is Coming
NYS plans on implementing the lookback period/transfer penalty by late 2025. According to New York Legal Assistance Group (NYLAG), this Medicaid 2.5-year lookback/transfer penalty cannot occur until the following requirements are completed:
- Centers for Medicare and Medicaid Services (CMS) approves NYS’ spending of American Rescue Plan funds
- Letter issued by CMS in approximately July 2025
- CMS approves State Plan Amendment of the Medicaid Plan
- CMS approves DOH’s request to amend the 1115 waiver to allow a lookback
- Currently pending
- DOH issues directives to local Medicaid agencies
- Has not occurred as of now
What Should You Do?
If you feel that Community Medicaid may assist you or someone you know in getting home care paid for by Medicaid, take action now. Contact Care Answered today and let’s discuss your care solutions. We get healthcare DONE. Book a free consultation now or email nicole@careanswered.com