NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A1907
SPONSOR: Paulin TITLE OF BILL:
An act to amend the social services law, in relation to eliminating a
"look-back period" for home care for non-institutionalized Medicaid
applicants; and repealing certain provisions of such law relating there-
to
PURPOSE:
To eliminate a look-back period for home care for home health care Medi-
caid applicants.
SUMMARY OF PROVISIONS:
Section 1: repeals the definition of a non-institutionalized individual
Section 2: Removes the consideration of asset transfers for non-institu-
tionalized individuals for eligibility for community based long term
care service.
Section 3: Removes the 30 month period for non-institutionalized indi-
viduals in the definition of a look-back period.
Section 4: Sets the effective date
JUSTIFICATION:
The SFY 2020-21 enacted budget added a 30 month "look back" period for
home health care Medicaid applicants. A look back period is a duration
of time during which the government reviews an individual's financial
transactions to determine whether they have transferred assets for less
than fair market value in order to qualify for Medicaid coverage for
long-term care. Look back periods had never applied to home health care
previous to the SFY 2020-21 enacted budget provision, and the change
makes it more difficult for seniors to be eligible for Medicaid and
homecare.
Prior to the look back period requirement, health care Medicaid approval
was much faster, which is vital for senior citizens and those with disa-
bilities since home care agencies cannot provide free care while appli-
cants wait extended periods of time for Medicaid approval. Around the
clock home care can cost as much as a nursing home, which will push more
people into nursing homes where at least care will start immediately.
This bill will repeal the look back period for home health care Medicaid
applicants so that older adults and people with disabilities will not
find themselves unnecessarily locked out of services that would protect
them in their homes and keep them safe from unnecessary institutionali-
zation.
LEGISLATIVE HISTORY:.
2024: A9279, referred to health/Same as S6414, committed to rules
FISCAL IMPLICATIONS:
To be determined.
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
1907
2025-2026 Regular Sessions
IN ASSEMBLY
January 14, 2025
___________
Introduced by M. of A. PAULIN, DAVILA -- read once and referred to the
Committee on Health
AN ACT to amend the social services law, in relation to eliminating a
"look-back period" for home care for non-institutionalized Medicaid
applicants; and repealing certain provisions of such law relating
thereto
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Clause (xi) of subparagraph 1 of paragraph (e) of subdivi-
2 sion 5 of section 366 of the social services law is REPEALED.
3 § 2. The opening paragraph of subparagraph 3 of paragraph (e) of
4 subdivision 5 of section 366 of the social services law, as amended by
5 section 14 of part MM of chapter 56 of the laws of 2020, is amended to
6 read as follows:
7 In determining the medical assistance eligibility of an institutional-
8 ized individual, any transfer of an asset by the individual or the indi-
9 vidual's spouse for less than fair market value made within or after the
10 look-back period shall render the individual ineligible for nursing
11 facility services for the period of time specified in subparagraph five
12 of this paragraph. [In determining the medical assistance eligibility of
13 a non-institutionalized individual, any transfer of an asset by the
14 individual or the individual's spouse for less than fair market value
15 made within or after the look-back period shall render the individual
16 ineligible for community based long term care services for the period of
17 time specified in subparagraph five of this paragraph.] For purposes of
18 this paragraph:
19 § 3. Clause (vi) of subparagraph 1 of paragraph (e) of subdivision 5
20 of section 366 of the social services law, as amended by section 13 of
21 part MM of chapter 56 of the laws of 2020, is amended to read as
22 follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD05294-01-5
A. 1907 2
1 (vi) "look-back period" means the sixty-month period immediately
2 preceding the date that an institutionalized individual is both institu-
3 tionalized and has applied for medical assistance[, or in the case of a
4 non-institutionalized individual, subject to federal approval, the thir-
5 ty-month period immediately preceding the date that such non-institu-
6 tionalized individual applies for medical assistance coverage of long
7 term care services. Nothing herein precludes a review of eligibility for
8 retroactive authorization for medical expenses incurred during the three
9 months prior to the month of application for medical assistance].
10 § 4. This act shall take effect immediately.
