New Medicaid Home Care Penalty Transfer Rules

Hynes & Chu, LLP ~ Attorneys at Law

New York State Senate Amends State Medicaid Program to Expand Transfer Penalty Rules to Community Home Care Services

In an effort to reduce the annual New York State Medicaid budget of $70 billion, the State of New York has amended the law governing the State Medicaid program, to include new restrictions on people applying for home care services in the community.

What is about to change:

Due to the need to reduce the size of the New York State Budget, Governor Cuomo set up a "Medicaid Redesign Team" to find ways to reduce the cost of the state's Medicaid Program. Among the changes suggested was to impose a "Lookback" and a "Transfer Penalty" on application for community based home care applications, similar to the lookback and transfer penalties that now exist for Medicaid nursing home applications. This proposal was accepted and approved March 2021 as part of the New York State budget for 2021, however *Actual implementation of the new look-back has been delayed until late 2025 or early 2026 due to the delays caused by the Covid Emergency.

Description of what is about to change:

It is a manditory part of the Federal Medicaid Program that application for nursing home coverage be subject to a five year "Lookback" and "Transfer Penalty". However, each state that participates in the Medicaid Program has always had the option to impose a look back and transfer penalty on applications for community based home care services. Starting some time in early 2026, New York State will impose a 30 month (30 months = 2.5 years) lookback on applications for Medicaid home care services. If any non-exempt transfers of assets or income were made by the applicant (or their spouse) in the lookback period, a penalty waiting period will be imposed on the applicant based upon the value of the transfers. During the penalty period the applicant will not be eligible to receive community based Medicaid home care services. The "Lookback" will only look for transfers that occured on or after the new home care look-back rule is implemented. We shall provide updated information as it becomes available.

This is a new program change and no other detials are available at this time - this page will be updated as more information about the implementation of this new rule becomes available.