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Is There a Look-Back Period for Community Medicaid in New York?
Currently in New York State, the imposition of a look-back only applies to those applying for nursing home Medicaid. As of now, if applying for Community Medicaid, no look-back will apply. While there was a law passed in 2020 placing a 30-month look-back on the Community Medicaid program, for various reasons this has not yet been implemented in New York State.
Making sense of the complicated laws, rules and regulations surrounding an application for long-term care (“LTC”) Medicaid can be daunting. Part of the confusion comes from a misunderstanding about the two different types of LTC Medicaid coverage. Within eligibility comes the concept of a “look-back.”
Community Medicaid is the program that covers, among other services, home health aide coverage in the home. Institutional Medicaid covers skilled nursing facility services, i.e. nursing homes.
The look-back is used by the Medicaid program to determine if any assets were given away prior to applying for the program for the purpose of achieving eligibility. The words “transfers” and “gifts” are commonly used. This can include transfer of assets to a Medicaid Asset Protection Trust, gifts to friends and family, and any other use of your funds that is not for the benefit of you or your spouse. Buying yourself a new car or spending on a personal purchase will not be penalized.
5-Year Look-Back Window for Nursing Home Medicaid
The current look-back is 60 months (5 years) for nursing home Medicaid. This means that you will be penalized for transfers made by you or your spouse during the five years preceding an application by either one of you for nursing home Medicaid. The penalty is based on a legal presumption that the assets were given away to qualify you for the program. However, depending on the facts and circumstances surrounding the transfer, a penalty may be avoided in some cases.
Understanding Medicaid Penalties
On Long Island, a one-month penalty will be assessed for every $14,668 that you transfer within the look-back. For example, if $75,000 is transferred during the 5 years preceding an application for institutional Medicaid, there would be a 5.11-month penalty assessed. This is the amount of time for which there would be no coverage from Medicaid and the patient would need to privately pay for the facility.
Whether or not planning was done in advance, there are tools that can be used to preserve some assets. While we do not currently have a look-back for community Medicaid, it may be on the horizon, so the look-back should be considered in any estate planning with a view towards long term care.
Britt Burner, Esq. is a Partner at Burner Prudenti Law, P.C. focusing her practice areas on Estate Planning and Elder Law. Burner Prudenti Law, P.C. serves clients from New York City to the east end of Long Island with offices located in East Setauket, Westhampton Beach, Manhattan and East Hampton.
