The 2 lookback periods that apply for long-term care Medicaid

On Behalf of | Oct 6, 2023 | Medicaid Planning |

Older adults in New York can generally rely on Medicare coverage to help pay for their basic expenses, including routine medical care. However, those experiencing medical challenges as they age often need more than just doctor’s appointments and occasional treatment. They may require extensive support either in their own homes or in a professional facility like a nursing home.

To pay for such care, they may require New York Medicaid benefits instead of Medicare coverage. When someone applies for Medicaid, there is a major review of their recent financial activity, not just their current holdings. Gifts or transfers made during the applicable lookback period could result in a financial penalty. Those seeking Medicaid for long-term care in New York could be subject to one of two different lookback periods.

The community care lookback period

Those who want to age in place and who require some support to do so may qualify for Medicaid benefits to pay for certain services. Community-based Medicaid coverage can pay for adult daycare services, routine nursing visits at someone’s home and home care services, along with other types of care. New York has sought to make such coverage more accessible by separating it from residential long-term care. Those applying for community-based care Medicaid coverage will only be subject to a 30-month review of their financial transactions.

The residential care lookback period

Someone moving into a nursing home or similar facility will likely have much higher costs than someone who simply needs adult daycare Services or similar support. Therefore, the New York Medicaid program will look back at more of their financial records when they apply. Residential long-term care applicants face a 60-month or five-year financial review. If they made large transfers or gifts during those five years, the state might impose a penalty. The older adult may have to pay for a certain number of months of care with their own resources before the state will begin covering those costs.

The more extensive someone’s support needs are or are likely to become, the more important advanced planning becomes. Integrating Medicaid planning into the estate planning process can, for starters, help older adults avoid penalties if they ever require Medicaid coverage.