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State Seeks Approval of 30-Month Lookback for Medicaid HCBS

The Department of Health (DOH) is seeking approval from the Centers for Medicare and Medicaid Services (CMS) to amend its Medicaid Redesign Team (MRT) Section 1115 Waiver authority to implement a 30-month transfer of assets lookback period for coverage of community based long term care (CBLTC) services under managed care, which takes effect for Medicaid applications made on or after Jan. 1, 2021. A corresponding change is planned for the Medicaid fee-for-service (FFS) program through an upcoming Medicaid State Plan Amendment request to CMS. DOH also published a public notice on the proposal in the Aug. 19, 2020 State Register beginning on page 75.

The final budget for State Fiscal Year 2020-21 authorized the asset transfer lookback period on applicants for Medicaid coverage of CBLTC services. Applicants who transfer assets for less than fair market value within 30 months prior to their application for Medicaid will be subject to a “penalty period” in which their Medicaid eligibility for CBLTC services will be delayed based on the amount of the transfer(s) and the monthly cost of care. The CBLTC services that will be subject to this penalty period include:

  • Certified home health agency
  • Private duty nursing
  • Personal care
  • Limited licensed home care agency
  • Assisted living program
  • Adult day health care
  • Consumer directed personal assistance
  • Enrollment in Managed Long Term Care (MLTC) in the community

Enrollees in mainstream Medicaid managed care and Medicaid Advantage plans, and beneficiaries receiving Medicaid Section 1915(c) and (d) waiver services (including the Traumatic Brain Injury (TBI) and Nursing Home Transition and Diversion (NHTD) waivers) are excluded from the lookback period. An undue hardship provision, which is required under federal law, is incorporated in the State’s proposal. Applicants for nursing home services continue to be subject to the current asset transfer lookback period of 60 months.

If approved, effective Jan. 1, 2021, DOH will exercise waiver authority to:

  • Impose the 30-month transfer of assets provision on individuals newly seeking CBLTC services through Medicaid FFS or MLTC plan enrollment on or after Jan. 1, 2021, not on beneficiaries already receiving CBLTC services as of that date; and
  • Phase in the application of the CBLTC transfer rules and 30-month lookback on Jan. 1, 2021, meaning that applications for CBLTC services submitted on or after that date would be assessed for any asset transfers made on or after Oct. 1, 2020.

The State estimates that this change will annually impact roughly 2,700 applicants seeking CBLTC services through MLTC plans and 40 applicants through Medicaid FFS, resulting in combined annual savings of $5.05 million to the state and federal governments.

Contact: Dan Heim, dheim@leadingageny.org, 518-461-2934