By Brian L. Miller, Esq.

Recently, there have been significant changes to the New York State Medicaid programs for New Yorkers who are age 65+, blind or disabled. As discussed in our prior blogs, New York passed a law in April 2020 to implement a 30-month (two and a half year) lookback period for all Community Medicaid applications.  This law was intended to take effect in October 2020 but has been pushed back several times since then. 

Today, the 30-month lookback has not yet been approved by CMS, because the federal agency who needs to approve the changes and is unlikely to take effect before October 1, 2022. Additionally, the implementation of needing physical assistance with three activities of daily living to be eligible for Community Medicaid has also been delayed. This should not take effect until October 1, 2022 at the earliest.

What has changed?

For those applying for Community Medicaid, New York has implemented an “Independent Assessor” evaluation for all home care cases.  Any applicant who has submitted a Community Medicaid application on or after May 16, 2022 will now have to undergo an Independent Assessment (a/k/a Community Health Assessment) to assess the applicant’s needs for home care.  This examination can be done in person or via telehealth. 

In addition to the Independent Assessor, the Medicaid applicant will need be evaluated by an Independent Practitioner Panel by scheduling a clinical appointment and then obtain a practitioner’s order detailing the applicant’s medical necessity.  This replaces the prior procedure of having the applicant’s treating physician complete a form detailing their medical necessity. 

One of the biggest changes is the implementation of an “Independent Review Panel”.  If a Medicaid applicant needs care of more than twelve hours per day, their file will now be reviewed by an Independent Review Panel.  If the panel determines that the applicant does not require more than twelve hours per day of care, the decision may be appealed.

Some Good News

While it is more cumbersome to obtain care with the new evaluations, the financial constraints will be loosening up starting January 1, 2023.  For all applicants applying for Community Medicaid after January 1, 2023 (and Medicaid recipients who will recertify after January 1, 2023), the Medicaid income limit will increase to 138% of the Federal Poverty Line (“FPL”). 

While we cannot calculate the income limit until next year’s FPL is released by the government, if you were to calculate the amount using this year’s FPL a single individual would be allowed income of $1,563 per month.  Currently an applicant is allowed income of only $954 per month. Notably, the use of a pooled trust is still available for both current and future Medicaid recipients to shelter their excess income above these limits.

Similarly, an individual’s available resources limits will also be increased.  Currently, an individual applying for (or receiving) Community and/or Nursing Home Medicaid benefits is allowed $16,800 of available resources.  Once the new law takes effect on January 1, 2023 a Medicaid applicant is able to keep approximately $28,134 in non-exempt assets.  This calculation based upon the 2022 FPL so is not accurate as to what it will be in 2023.

Navigating these new policies can be confusing.  At Littman Krooks, our attorneys and trusted team are here to assist you with your asset and income protection planning; Medicaid application and obtaining the necessary care.  Do not hesitate to contact us to schedule a no obligation consultation to discuss your particular needs.