When the state of New York passed legislation in 2020 creating a 30-month lookback period for uncompensated transfers of assets under the Medicaid home care program, few imagined that almost five years later, the law would still not be in effect. While uncompensated transfers currently trigger a five-year lookback period for institutional (nursing home) Medicaid, individuals seeking home care services funded by Medicaid have continued to transfer assets—such as through gifts or an Irrevocable Medicaid Asset Protection Trust (MAPT)—without affecting their eligibility for Medicaid home care.

In recent months, however, the Medicaid home care program has come under increased scrutiny from Governor Hochul’s administration. As of Apr. 1, 2025, New York will require individuals enrolled in the Consumer Directed Personal Assistance Program (CDPAP) to switch from their current fiscal intermediary to Public Partnerships, LLC (PPL), a single fiscal intermediary. CDPAP allows applicants to designate a caregiver of their choosing (excluding spouses) to be paid by Medicaid for approved hours of care.

Prior to this change, CDPAP consumers could choose from over 600 fiscal intermediaries that would process caregiver payments. These fiscal intermediaries are required to close by April 1, 2025. PPL, a Georgia-based company the Hochul administration selected, will be responsible for registering all 250,000 CDPAP participants and their caregivers, bringing the entire program under one roof. The objective of this change is to limit fraud within the CDPAP Program.

Of the 600-plus former fiscal intermediaries, only 42 were granted “approved facilitator” status and are permitted to assist PPL with the registration process. One can only hope that PPL is adequately prepared for the task!

In addition to this significant administrative change, there have been recent rumblings that New York will finally implement the 30-month lookback period for uncompensated transfers made for Medicaid home care in either 2025 or 2026.

In my opinion, this should give seniors beginning to experience age-related challenges with daily living activities—walking, dressing, feeding, toileting, bathing—the push they need to consider engaging in Medicaid planning, including transferring assets to a MAPT. Seniors who currently require home care assistance should immediately apply for Medicaid home care to avoid being subject to the 30-month lookback period once it is implemented.

Most recently, the New York State Senate has proposed increasing the resource eligibility amount for home care and nursing home Medicaid from $32,396 to $300,000 per person. While this large increase would allow New York seniors to retain more of their assets and still receive Medicaid benefits, I believe it could also severely impact the number of seniors eligible for Medicaid home care or Medicaid nursing homes and strain the Medicaid system in New York.

Interestingly, all of the changes and proposals discussed here are at the state level—there have been no corresponding federal changes to the Medicaid program.