that an authorized refill of the prescription has been transferred; the name, address and telephone number of the pharmacy from which it was transferred; the name of the pharmacist receiving the prescription information; the name of the pharmacist transferring the information; the date of the original prescription and most recent transfer; and
It is common to hear that a nursing home Medicaid application can take up to an entire year due to all the documentation that is needed for the look-back. If you are married and your Medicaid eligibility is determined under spousal impoverishment budgeting with post-eligibility rules (e.g. A very simplified example might be that one state requires an applicant to need assistance with two activities of daily living, while another state requires assistance with three activities of daily living. However, the current is that individuals who are already enrolled in Medicaid long-term care services will be grandfathered into the program and eligibility will continue regardless of past financial transfers.Generally, the LDSS will want further clarification as to where or how certain large transfers were spent. The New York State (NYS) Legislature passed the Fiscal Year 2020-2021 budget on Friday, April 3, 2020. Therefore, Medicaid eligibility requirements are not consistent across states. There are concerns that if this were the case, then when Medicaid enrollees are due to recertify, a look-back could result in them having a penalty period imposed on them and potentially losing services.
New York’s rules … For example, if an individual transfers property during the look-back period, then the LDSS will inquire as to how the proceeds from the transfer were spent.
Thankfully, through the strong advocacy efforts of members of our Legislature, the spousal impoverishment provisions remain intact, permitting community spouses to keep income and assets that allow for a practical standard of living and prevent poverty.Spousal impoverishment budgeting was designed to prevent a community spouse, who does not need Medicaid covered services, from having to pay large portions of his or her income and resources towards the cost of care for the “sick” spouse, often referred to as the institutionalized spouse.
Fortunately, there is retroactive Medicaid coverage available. For individuals with a dementia or Alzheimer’s diagnosis, eligibility for enrollment is met if it is found that When determining whether an individual is eligible to enroll in a program like CDPAP, an assessment of the individual’s ability to perform ADLs and what level of assistance may be necessary in order to complete the ADLs must be done. This is because there is a presumption in the law that large transfers made during the look-back period were done for the purpose of qualifying for Medicaid. If an exception cannot be met nor a valid explanation can be provided as to why the funds were transferred during the look-back period, then the LDSS will impose a transfer penalty upon the person seeking Medicaid coverage.Currently, it appears that the formula used when calculating a transfer penalty for long-term services in the community will be the same as that used when calculating transfer penalties for nursing home Medicaid applicants. Also, while there is nothing in the new legislation to indicate immediate need applications for Medicaid will be delayed, individuals will still need to meet the heightened criteria for Medicaid eligibility.
Again, professional Medicaid planners can be of assistance in this situation.Copyright © 2020 All rights reserved. This means one must close their Medic… 4. This site is for information purposes; it is not a substitute for professional legal advice.
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