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Jay J. Sangerman, PLLC
171 East 84th Street, Suite 21B
New York, New York 10028
212-922-0711
212-439-0056 - facsimile
Pursuant to the New York State Budget Bill and the federal Deficit Reduction Act, the following has occurred. The rules have been published as of July 20, 2006. [THIS PAGE IS UNDER CONSTRUCTION]
FOR A COMPLETE OUTLINE OF THE 2006 MEDICAID RULES, PLEASE CLICK HERE.
1. Spousal Refusal has not been eliminated.
2. Transfer of assets will not cause a period of ineligibility for community (homecare) Medicaid.
3. The Deficit Reduction Act provisions apply. Click here.
4. There is a five (5) year look-back period for determining penalties, but the full-five year look-back period will not take effect until 2011.
The look-back period for transfers made on or after February 8, 2006, is increased from 36 to 60 months for individuals applying for Medicaid coverage of nursing facility services.
In the case of a transfer of assets made on or after February 8, 2006, the begin date of the period of ineligibility is the first day of the month after which assets have been transferred for less than fair market value, or the date on which the otherwise eligible individual is receiving nursing facility services for which Medicaid coverage would be available but for the imposition of a transfer penalty, whichever is later, and which does not occur during any other penalty period.
5. Significant issues with the possibility of home equity being counted as an asset.
Section 366.2(a)(1) of the SSL is amended to require that for applications for nursing facility services and community-based long-term care services made on or after January 1, 2006, an individual will not be eligible for such care and services if the individual’s equity interest in his or her home exceeds $750,000. This is the maximum amount allowed under the DRA. Individuals cannot spend down excess equity with the use of medical bills. The home equity limitation does not apply if one or more of the following persons are lawfully residing in the individual’s home:
• the spouse of the individual; or
• the individual’s child who is under age 21, or certified blind or certified disabled.
6. Significant changes in reference to annuities and the closing of loopholes.
For annuities purchased on or after February 8, 2006, the A/R must be informed of the right of the State to be named remainder beneficiary by virtue of the provision of Medicaid.
An otherwise eligible A/R will be provided Medicaid coverage of long-term care services if the A/R meets an undue hardship. Undue hardship exists when the denial of Medicaid coverage would:
• deprive the A/R of medical care such that the individual’s health or life would be endangered; or
• deprive the A/R of food, clothing, shelter, or other necessities of life;
and there is a legal impediment that prevents the A/R from being able to access his or her equity interest in the property.
Continuing Care Retirement Communities (CCRCs) offer a range of housing and health care services to serve older individuals as they age and as their health care needs change over time. CCRCs generally offer independent living units, assisted living, and nursing facility care for individuals who can afford to pay entrance fees and who often reside in such CCRCs throughout their older years. The services generally offered include meals, transportation, emergency response systems, and on-site nursing and physician services. Many also offer home care, housekeeping, and laundry services.
Individuals with contracts for admission to a State licensed, registered, certified or equivalent continuing care retirement or life care community may be required to spend on their care resources declared for purposes of admission before applying for Medicaid. Under certain circumstances an individual’s paid entrance fee to a CCRC or life care community will be considered a resource when determining Medicaid eligibility.
FOR A COMPLETE OUTLINE OF THE 2006 MEDICAID RULES, PLEASE CLICK HERE.