Client Alert: Big Changes Are Coming To Medicaid

By Moriah Adamo and Ellyn Kravitz

The 2021 State Budget imposes sweeping changes to New York’s Medicaid Program, adversely affecting both individuals and providers who require funding for Long-Term Health Care Services. Below are highlights of the changes:

Changes in Financial Eligibility

30 Month Look Back Period for Medicaid Home Care Services

Effective October 1, 2020 a 30 month (2 ½ year) look back period for asset transfers will apply when determining eligibility for Medicaid for those seeking home and community based long-term care services and supports. Uncompensated transfers made during this look back period will result in the imposition of a penalty calculated in the same manner as institutional Medicaid. This is applicable to applications for personal care services, consumer directed personal care services, assisted living program services and other community based long-term care services.

Reduction of Home Care Service Delivery

Modified Eligibility for Home Care Services

Effective October 1, 2020, for new applicants to be eligible to receive home care services, an individual must be assessed to need assistance with a least three activities of daily living (ADLs) (ranging from limited assistance to total dependence). There is a carve out for Alzheimer’s or dementia patients requiring assistance with only one ADL. The tasking tool must determine “whether the individual is capable of safely remaining in the community.” By April 1, 2021, the Department of Health must develop a new tasking tool.

Assessments of Home Care Hours

A Department of Health selected independent physician must prescribe a plan of care. A Department of Health approved tasking tool must be used in determining an award of home care services. By October 1, 2022, the Department of Health, or, more likely, its contractor, will establish a panel of clinical professionals to order home services and conduct assessments and reassessments for home care hours. Reassessments for home care hours will now be required annually, not bi-annually.

Modifications to Consumer Directed Assistance Program

Districts no longer required to give notice of the availability of the program.

Moratorium of Managed Long-Term Care Plan (MLTCs)

Effective April 1, 2020 through March 31, 2022 State will generally not accept nor process applications for MLTC plans to enter the market. The State shall phase out all non-FIDA plans and limit enrollment for each plan through premium withholdings. However, consumers are still required to enroll in MLTCs.

Reduction in Nursing Home Reimbursement

Reduce nursing home capital reimbursement by 5% and eliminate return on equity payments to for-profit nursing homes.

The attorneys at Abrams Fensterman are closely monitoring these changes and provide updates as they become available.

If you are in individual with any questions about the impact of these changes on yourself or loved one, feel free to contact Moriah Adamo, Esq. (516) 328-2300 or Ellyn S. Kravitz, Esq. (212) 279-9200

If you are a health care provider with specific concerns or questions about any of the above issues as they relate to your facility, feel free to contact Nancy Levitin, Esq., Jeffrey Neuman, Esq., Gregory S. Choi., Esq, or any Abrams Fensterman healthcare attorney at (516) 328-2300.