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How does the New York Medicaid lookback period affect you?

On Behalf of | Mar 11, 2022 | Medicaid

Applying for Medicaid means opening yourself up to financial scrutiny. In New York, applicants need to prove that they do not have the income or assets to cover all of their medical costs themselves. Their current financial information and years of records will be subject to state review before they receive benefits.

Often, people don’t realize until a medical emergency that they might need to qualify for Medicaid. These applicants may make frantic, last-minute plans before they apply. However, the look-back period for Medicaid in New York will potentially affect their claims.

Someone who needs certain benefits will face scrutiny by their financial backers going back 60 months or five full years. Understanding both the current rules and upcoming changes can help those planning for their future care needs.

What does the look-back period do?

The lookback period is a window of time where your financial activity can affect benefits eligibility. If the person reviewing your finances determines that transfers made during the lookback period are inappropriate or fraudulent, you will be subject to a penalty.

The state will figure out how much money could have gone toward your health care costs and will then translate that to a specific number of months of service. You will have to cover those costs yourself for that set number of months before the benefits will start.

What is the upcoming Medicaid change?

New York adopted changes to its Medicaid rules some time ago, but the enactment of those new rules has taken some time. Broader social and health issues have resulted in the repeated delay of the changes.

The lookback rule that has long applied to Medicaid applications for nursing home care will soon apply to those applying to pay for long-term home care as well. Although the state had announced the implementation of the new lookback rules on April 1, 2022, it now looks like it may be July before the new rules take place.

Advance planning is the only surefire way to avoid triggering those penalties and leaving yourself unable to pay for the care you absolutely need. Paying for nursing home support or in-home nursing care costs thousands of dollars a month. Even those who have aggressively saved for retirement may not be able to afford those costs.

Understanding the New York rules for Medicaid applicants will make it easier for you to plan for Medicaid benefits.