On February 4, 2020, Gov. Cuomo convened a Medicaid Redesign Team (MRT II), tasked with finding $2.5 billion worth of cuts – or savings – from the Medicaid program in time for the April 1, 2020 New York State Budget. The team met for the first time on February 11th and then again on March 9th. On March 19th, they approved a proposal of $2.5 billion in cuts and submitted same to the Governor. Amid the height of the coronavirus crisis, the State passed the budget, including these cuts. This is proving to be a significant challenge as the Department of Health and the local departments of social services strain to figure out how to implement accommodations so they can continue functioning and providing services during this unprecedented crisis. With health care being in a state of emergency, seniors are now also faced with the prospect of losing access to services with hardly any warning.
Home Care Medicaid will now have a 30-month lookback period. This change was slated to become effective April 1, 2020. Because of the state of emergency, the effective date was pushed back to October 1, 2020. What this means is that for any home care application filed on or after October 1st, the agency will look back 30 months (2 1/2 years) to see if any uncompensated transfers of assets were made during that time period. This will work the same way as an institutional Medicaid application, except that the look back period is shorter. It appears that the same rules will apply to home care as apply to institutional Medicaid in terms of exempt assets and transfers. As a practical matter, if an individual is in the process of doing assets transfers now in contemplation of filing for Medicaid home care, the application must be made by October 1st; otherwise those transfers will be penalized. We believe we will be using the same asset preservation techniques we currently use for institutional Medicaid, such as Gift/Note planning.
Individuals who enroll in the Consumer Directed Personal Assistance Program (CDPAP) on or after October 1, 2020 must require assistance with at least 3 Activities of Daily Living (ADLs) and those with Alzheimer’s or dementia must require assistance with 2 ADLs. This provision will apply to individuals who receive initial authorization for services on or after October 1, 2020. Those individuals currently receiving services will not be subject to the new requirements – unless services are for some reason interrupted and a new service authorization is needed. This new provision will absolutely reduce the number of people who receive services.
Effective October 1, 2022, independent assessors procured by the Department of Health will perform the assessments currently performed by the local departments of social services and the MLTCs. It would appear that the assessments currently done by the MLTC or by the local Medicaid offices will now be done by an independent entity – probably similar to the way the Maximus evaluations are now conducted. The effective date of this provision is over two years out, so more information about this process will likely trickle out in the future. Considering the monetary incentive the MLTCs presently have to give as few hours as possible, this change may be a positive one. We will have to wait and see.
As with all changes affecting seniors, we will adapt and find workarounds. However, it is more important than ever for people to do their estate planning before long-term care services are needed. We are here to help.