New York Community Medicaid Lookback Delayed: Implementation Not Expected Until 2025

We are following up on our previous post from April 28, 2023, informing you that the New York Medicaid lookback start date is on hold.

"We still have not received any more on this from CMS," said Lisa Sbrana, Director of the Division of Eligibility and Marketplace Integration of the Office of Health Insurance Programs of the New York State Department of Health. She explained that the reason the lookback cannot be implemented is that CMS has made no decision on the waiver request.

"Since we are nearly in 2024, even if it was approved by CMS it could not go forward next year," Sbrana informed. She thinks that the earliest implementation if CMS approves the lookback "would be sometime in 2025."

CMS stands for Centers for Medicare and Medicaid Services, which is the federal agency that oversees the Medicaid program and sets the rules and standards for states to follow. CMS also provides funding and technical assistance to states to help them administer their Medicaid programs. In New York, the state agency that runs the Medicaid program is the New York State Department of Health (NYSDOH). NYSDOH works with CMS to ensure that New York's Medicaid program meets the federal requirements and provides quality health care to eligible New Yorkers.

What does a lookback for Community Medicaid mean? Essentially, it means that when someone applies for Community Medicaid benefits, their financial history will be reviewed for the 30 months prior to their application date. This is known as the "lookback period." During this time, any transfers of assets or gifts made by the applicant will be evaluated to determine if they were made for the purpose of qualifying for Medicaid benefits.

Why is this important? Currently, there is no lookback period for Community Medicaid. This means that someone can transfer assets or give gifts just before applying for benefits in order to meet the financial eligibility requirements. However, the new lookback period is meant to prevent this planning strategy.

Of course, there are some exceptions to the lookback period. For example, transfers made for the sole purpose of benefiting a spouse or disabled child are not subject to review. Additionally, there is a hardship waiver available for those who transferred assets for reasons beyond their control, such as a sudden illness or job loss.

Overall, it's important to be aware of changes to New York's Medicaid program. The good news is that we have a longer window of opportunity to transfer assets without a lookback for Community Medicaid. It is advisable for anyone who needs or may need community-based Medicaid services, such as home care or assisted living, to apply as soon as possible before the lookback takes effect.