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New HCBS 30-Month Lookback Policy Sent to CMS for Approval

The Department of Health's (DOH) 1115 Waiver amendment seeking to implement a 30-month transfer of assets lookback for Medicaid coverage of community-based long term care (CBLTC) services has been submitted to the Centers for Medicare and Medicaid Services (CMS) for approval. Copies of the final waiver application and completeness letter from CMS have been posted on the Department’s Medicaid Redesign Team (MRT) II website.

Enacted in last year's State budget, the amendment sets a 30-month transfer of assets lookback for those seeking to obtain Medicaid coverage of CBLTC services. The following are the CBLTC services that the State plans to impact by this initiative:

  • Adult day health care
  • Assisted living program (ALP)
  • Certified home health agency (CHHA) services
  • Personal care services
  • Consumer Directed Personal Assistance Program
  • Limited licensed home care services
  • Private duty nursing services
  • Managed Long Term Care (MLTC) in the community*

The State will seek approval under Section 1115 to impose the lookback with a modified phase-in, meaning a full 30-month retroactive review will not be applied on Jan. 1, 2022. Under New York’s April 2, 2020 statutory change, the transfer of assets rules for CBLTC services are effective Oct. 1, 2020. Therefore, the State is seeking to begin applying the CBLTC transfer rules on Jan. 1, 2022, meaning applications for CBLTC services submitted on or after Jan. 1, 2022 would be assessed for any transfers made on or after Oct. 1, 2020.

This initiative does not pertain to waiver services obtained pursuant to 1915(c) or (d) of the Social Security Act, which are waiver services provided through the Traumatic Brain Injury Program, the Nursing Home Transition and Diversion Waiver Program, the consolidated 1915(c) waiver for children, and the Office for People with Developmental Disabilities’ (OPWDD) Comprehensive Home and Community-Based 1915(c) waiver.

CMS will be accepting public comments on the waiver application from April 9, 2021 through May 9, 2021 via the methods described on the CMS website.

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342