Medicaid Planning Look-Back Period for New York

Our Dedicated Elder Law Attorneys Explain NY Medicaid and How the New Look Back Deadlines Affect You

If you’re a New Yorker 65 or older or have a loved one who is, you may be thinking about long-term health care needs. As you age, it’s possible you’ll need to reside in a nursing home—however, Medicare insurance won’t provide the financial support you’ll need to pay for it. Ultimately, you may look to Institutional Medicaid to pay for the astronomical costs of a long-term care facility or Community-Based Medicaid to remain living at home or in an assisted living facility.

The dedicated and knowledgeable elder law and Medicaid planning attorneys at Landskind & Ricaforte Law Group, P.C., understand the challenges you face when making decisions about long-term care. Not only is it expensive, but it can effectively drain your life’s savings and leave you with few assets after working your entire life to accumulate them. Our attorneys discuss the planned changes for New York Medicaid and how they impact you.   

What Is Medicaid?

Medicaid is a government medical assistance program for low-income Americans. Medicaid pays for long-term care if a patient becomes ill, disabled, or incapacitated. New York offers Institutional Medicaid for individuals who need long-term care in a nursing home and Community Medicaid for those who live in their own home, someone else’s home, or an assisted living facility. 

If you’ve never been eligible for Medicaid, you might think you won’t be eligible now, and you’re probably right. However, as one of the only government programs that will pay for nursing home care—Medicare does not—it’s worth finding out if you could become eligible through Medicaid planning.

To qualify for either Institutional or Community Medicaid, you must have limited income and assets, and any excess or surplus above that limit must be “spent down” or reduced before Medicaid provides financial support. If you’re not sure if you qualify for Medicaid, our experienced Medicaid planning attorneys are available to meet with you and review your circumstances. 

Be Aware of the Look-Back Period

The key to successful Medicaid planning is doing it far in advance of needing a nursing home. If the Medicaid trust was set up more than five years ago, you shouldn’t have a problem qualifying for Medicaid. 

However, in New York—and every other state except California—there is a five-year look-back period for people seeking long-term nursing home care. The look back period refers to Medicaid’s review of an applicant’s financial transfers within the five years prior to submitting an application. 

This means that if you spent, gave away, or funded a trust with the bulk of your assets for the purpose of qualifying for Medicaid in the last five years, that money will be counted in your assets, and you will not qualify for Medicaid when you need it most. For example, if you gave your niece $15,000 in the last five years as a way to reduce your total assets, Medicaid would flag this as a strategy to qualify for benefits. Once the look back is completed, Medicaid knows that your niece could return the money to you. Medicaid also examines any asset transfers that were made below fair market value. 

There are exceptions to the five-year look-back for transfers of funds to a spouse, disabled child, adult children caregivers, and for paying off debt, but these exceptions are difficult to implement without the help of an elder law Medicaid planning attorney.

Important Changes to Know Regarding NY Community-Based Medicaid

Although New York Medicaid has never had a look back period for Community-Based Medicaid benefits, plans have been in the works for the past few years to implement one. 

The 2024 plan for a 30-month look back period was scheduled to begin on March 1, 2024, but it has been unofficially delayed until sometime in 2025. However, it’s essential to begin planning for this change now, as a variety of different services are likely to be affected by the look back rule. They potentially include:

  • Assisted living facilities and programs
  • Personal care services
  • Adult daytime health care
  • Certified home health agency services
  • Consumer-directed personal assistance programs
  • Private nursing care
  • Limited licensed home care services

Taking Advantage of a Medicaid Trust and Other Possible Options for Spending Down Assets to Meet NY Medicaid Financial Limits

If your monthly income and nonexempt assets are above the strict financial limits set by NY Medicaid, you won’t be able to qualify for benefits unless you spend down your resources. 

The elder law and Medicaid planning attorneys at Landskind & Ricaforte Law Group, P.C. can discuss possible solutions that may help you reduce your assets and income to meet Medicaid requirements, including:

Medicaid Planning Is Complicated: Work With the Attorneys at Landskind & Ricaforte Law Group, P.C.

It’s not easy to apply for Medicaid, but having this health care benefit may be critical to your ability to afford quality nursing home care. If you’re a New Yorker and need long-term health care services but don’t know if you qualify for Medicaid, talk to Terence Ricaforte or Renata Landskind to discuss your situation. It’s critical to review the changes being made by Medicaid and maximize any asset protection available to you with a knowledgeable legal representative. We’ll discuss various ways to preserve your hard-earned assets—but you need to get started today. 

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