Rochester New York Medicaid Law

The New York State Department of Health issued an Administrative Directive on July 20, 2006, advising Social Services districts of the nursing facility services Medicaid eligibility provisions of the Deficit Reduction Act of 2005 (DRA).The major changes regarding Medicaid eligibility are:

  1. Increases the look-back period to sixty months for all transfers. The look-back period remains 36 months (60 months for trusts) until February 1, 2009 at which time resource documentation for the past 37 months (60 months for trusts) will be required. The look-back will increase by one-month increments until February 2011 at which time the full 60-month look-back period will be in place for all transfers of assets.

  2. Changes the date the penalty period begins to run. For assets have been transferred for less than fair market value, on or after February 8, 2006,the penalty period commences on the later of: (a) the month following the month in which the transfer is made (existing law) or (b) the date on which an individual is both receiving institutional level of care (i.e., in a nursing home or receiving care at home under the Lombardi Program) and whose application for Medicaid benefits would be approved but for the imposition of a penalty period at that time. To start the penalty period, the patients must have $4,000 or less at the time they receive institutional level care and apply for assistance.

  3. Home equity over $750,000 renders an applicant ineligible. This provision does not apply if a spouse or child under 21 or a child who is blind or disabled resides in the home. Homeowners can reduce their equity through a reverse mortgage or home equity loan.

  4. Annuities purchased after February 8, 2006, by the applicant or the applicant’s spouse must name the state as remainder beneficiary for at least the amount of Medicaid paid on behalf of the annuitant. Balloon payment annuities are a countable asset.

  5. Undue Hardship. For transfers made on or after February 8, 2006, undue hardship exists if the individual is not able to access the transferred assets and the individual’s health or life would be endangered without the provision of Medicaid for nursing facility services, or the transfer penalty would deprive the individual of food, clothing, shelter, or other necessities of life. Individuals applying for undue hardship must fully cooperate in the return of the transferred assets.

Certain sections of the DRA are not yet clear and may not be clarified for some time. Future state legislation, regulations and court cases will affect the DRA.