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The Latest on Understanding NY State’s New Medicaid Lookback Law

Understanding NY State’s New Medicaid Lookback Law

Latest update: As of July 14, 2022, although the new NY State Lookback was originally slated to go into effect in 2020, this date has been pushed to October 1, 2022. Community-based Medicaid Applicants and their spouses will be required to provide financial records/transactions that took place within the lookback period for up to 30 months.

So, if you need Community Medicaid or are looking to receive long-term home care benefits, you should start the process as soon as possible. Starting on October 1, 2022, applicants for community-based or home care Medicaid benefits will find the process to be more complicated due to the Medicaid Lookback Law in New York State. 

Applying early will avoid being subject to this new law that can make you ineligible or result in penalties. This article will help explain why.

Quick Review of the New Lookback Law in New York

The New York State community Lookback Law refers to a required time period prior to applications that are filed for Medicaid community and home care benefits for the review of asset transfers (gifts or sold). Records of all financial transactions will need to be provided by both spouses, even if only one is applying for benefits. 

This new law will affect all of those who apply for Community Medicaid and long-term home care benefits beginning October 1, 2022. Denial of eligibility and transfer penalties may be imposed if your assets are transferred below fair market value.

Updated Lookback Law Implementation Date

Although the date has been extended previously, it looks like this new law will be implemented beginning on October 1st, 2022. The law will require a minimum look-back period of 15 months and up to 2.5 years (30 months) for a review of any gifts or transfers you made during that time. 

The number of required months will increase due to a phasing-in of additional months until the total of 30 months for transfer records has been reached. Each month following October, for example, will add another month to the required lookback period until reaching 30 months. So, delayed applications will incur additional months required for the review of financial records.

How the NY State’s Lookback Law Works

  • You will not be subject to this new Lookback Law and will not incur transfer penalties if you file an application prior to the October start date.
  • After October 1, 2022, you (the applicant) and your spouse* will be required to supply any and all financial records during the designated lookback period.
  • *This is true whether or not your spouse needs Medicaid services. Also, even if your spouse refuses to comply, it is still required.
  • The lookback time frame is set to eventually increase from the initial 15 months up to 30 months and refers to the months preceding your application.
  • Asset transfers that take place during the lookback months prior to your application will signal the need for a review. The review will look at transfers that are below fair market value. 
  • Assets that have been transferred (as a gift or sold) below a fair market value within the lookback time frame could deem you ineligible for home care or community-based Medicaid benefits and/or incur transfer penalties.
  • Payment for Community Medicaid or long-term home care may be denied depending on the cash value of your transfers. If below fair market value, the cash values of these transfers will be used to establish how many months of payment will be denied by Medicaid. 

For the latest information and updates on this NY law, please visit the government website

What are the Exceptions to New York’s Community Lookback Law?

If you’re wondering if there are any exceptions to this new law, there are a few. For example, transfers and gifts that are given to your spouse are exempt. Here is the list of exemptions:

  • Any transfers before an application filed before October 1, 2022
  • Transfers and gifts to a spouse
  • Any transfers to a blind or disabled child
  • Transfers to a supplemental needs trust for a disabled person under the age of 65
  • Exempt assets, for example, Holocaust restitution

NY Community Medicaid and Long-Term Home Care Eligibility

Applicants who apply for Medicaid benefits in New York State may find themselves ineligible for community-based or long-term home health care as a result of the NY State community Lookback Law. In addition, these applicants may be subject to transfer penalties if assets were transferred under fair market value during a lookback period. All assets that were transferred during the lookback period will be subject to review. 

This lookback period, however, will not be applicable to those submitting their applications prior to the aforementioned October 1st date. If you are looking to receive these types of benefits and you apply after this date, you will be required to provide all of your financial records within the lookback time period that occurs prior to your application.

Lookback Law and the Effect on Nursing Home Medicaid

The New York State community Lookback Law is applicable to those in NY state who are specifically seeking Community Medicaid services or long-term home care benefits. 

Medicaid applicants seeking benefits for nursing home care are subject to a different law that requires a longer lookback period of 5 years. This NY state lookback law for nursing home care benefits meets Federal law requirements for all states to establish a lookback period for those seeking care in a nursing home facility.

Medicaid Planning for the Elderly

At KTS, we are more than happy to provide additional information on this NY law. Understanding the new Lookback Law should give you more reasons to think about preparing in advance for the eventuality of needed care for you or a loved one. You may find that applying now is the best solution if you have transferred assets that fall below fair market value in the recent past.

You may also want to seek legal advice from an attorney who specializes in elderly care law to be sure you are doing what’s best for you and your family. 

Remember, if you are concerned about your current situation and the assets you hold, you may still be eligible for Medicaid with a pooled trust. KTS can help you understand how a supplemental needs trust can help you qualify for community or long-term home Medicaid benefits. Contact us today.

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