Most of us do not think about it, but the reality is that we will likely need some form of long-term care as we age. Although most people think they need to go into a skilled nursing home facility, there are options for the home. Medicaid can help pay for this, but have you heard that there are some new rules?

The New York State Legislature passed some rather significant changes to the state’s Medicaid rules. Essentially, the changes placed more barriers for New York residents to obtain Medicaid benefits for long-term care, particular long-term care at home. For instance, the changes include requiring applicants for Community Medicaid to provide financial statements for the past 30 months. Community Medicaid is the program providing support for the care of clients at home. Any funds transferred from the applicant and/or the applicant’s spouse without fair consideration during the look-back period will result in a penalty period during which Medicaid will not pay out for at home care.

Additionally, there were some changes to provisions associated with Medicaid’s Consumer Directed Personal Assistance Program (CDPAP) and Personal Care Services Program (PCS). CDPAP gives Medicaid applicants the opportunity to hire family members, friends and other acquaintances as caregivers with salaries paid for by the program. PCS gives Medicaid recipients the option to receive personal care services with home care agencies that contract with the local department of social services. The changes in the law provide for the requirement of applicants to these programs to require assistance with at least three Activities of Daily Living (ADLs) which may include things such as personal hygiene, eating and dressing. Additionally, a qualified independent physician selected and approved by the Department of Health must prescribe the treatment plan.

Changes to New York’s Medicaid laws take effect on October 1, 2020 and they may have a profound impact on many New York residents. For questions regarding New York’s Medicaid changes as well as assistance navigating the Medicaid system, our office is here to help. Please reach out to us today to schedule a meeting.