By Patricia A. Rauh, Esq.
On April 2, 2020, the New York State Division of Eligibility and Marketplace Integration issued a General Information System (“GIS”) message to all Local District Commissioners and Medicaid Directors regarding changes to the Medicaid application and recertification process in light of the COVID-19 crisis. These changes are effective immediately and will remain in effect for the duration of this public health emergency. The purpose of this GIS is to ensure that no one who was in receipt of Medicaid coverage on or after March 18, 2020 will lose his or her Medicaid coverage unless he or she voluntarily terminates coverage or moves to another state. It also ensures that those applying for Medicaid coverage and are eligible for such coverage can quickly obtain benefits.
Typically, when an individual applies for Medicaid coverage, particularly long-term care coverage (i.e., nursing home care), he or she must submit all financial records for the past 60 months (the “look back period”) from the eligibility start date. This includes but is not limited to copies of bank statements, retirement account statements, life insurance policies, pension information, social security benefit information, annuity contracts, and federal income tax returns. If there is a community spouse, the spouse is also required to submit his or her financial information for the past 60 months. Additionally, the applicants residing in Erie County must also provide documentation for any transaction over $2,000.00 made on any account (some Western New York counties require documentation for lesser amounts). For example, if an applicant withdrew $3,000 from his or bank account during the look back period, he or she must provide proof of how the money was spent. The purpose of this requirement is to demonstrate to the Medicaid caseworker that there were no “uncompensated transfers” made during the 5-year look back period. In other words, caseworkers want to ensure that applicants have not gifted money in order to qualify for Medicaid coverage.
However, in light of the COVID-19 crisis, Medicaid applicants can now “self-attest” to their income and resource information. This means that applicants can simply list their resources and income information on the Access NY Medicaid Application and Supplement A form without providing the Department of Social Services with any supporting financial documents. In addition, the applicant may self-attest to any transfer of assets or transactions over $2,000.00 during the look back period.
It is important to note that this self-attestation does not apply to citizenship verification information. Applicants must still provide documentation proving citizenship (i.e., birth certificate or naturalization card). If the applicant cannot provide this information by the time the application needs to be submitted, the Department of Social Services will grant a 90 day extension of time for the applicant to provide such documentation. A second 90 day extension can be granted if the circumstances warrant a second extension.
Although individuals may be granted Medicaid coverage during this period without the need to submit financial documentation, they will be required to submit the five years’ worth of financial documents when it is time to recertify, typically a year following approval. Since applicants will be self-attesting to the amount of their resources, there is a possibility that an applicant may inaccurately represent the amount of his or her resources. This can create a situation where an applicant is approved for Medicaid coverage that he or she was not actually eligible for. This can be a very costly mistake. To put it into perspective, the current Western New York regional rate for nursing home care is $10,720.00 per month. That means that an individual could potentially receive $128,640.00 in Medicaid benefits that he or she was not eligible to receive over the course of a year.
The April 2, 2020 GIS does not specify how the Department of Social Services will handle a situation where someone erroneously received Medicaid benefits based on his or her misrepresentation of resources. Most likely, it will depend on the reason why the applicant was ineligible. If he or she is ineligible because he or she had resources in excess of the $15,750.00 limit, Medicaid may request to be reimbursed in the amount of the excess resources up to the amount of benefits paid. If the reason for ineligibility is due to uncompensated transfers made during the look back period, Medicaid may impose a transfer sanction that will begin at the time of recertification. For example, if the applicant made uncompensated transfers that would amount to a three month sanction, then the sanction period may begin from the date of recertification and continue for the following 3 months. During the sanction period, the individual would be deemed ineligible for Medicaid coverage and have to private pay for the cost of nursing home care until the sanction period ends.
Attorneys who are assisting clients with Medicaid applications during this self-attestation period should still try to obtain as much financial information from the client prior to submitting the application. If the client cannot obtain all of the documents, he or she should sign authorizations allowing the attorney to obtain the information on his or her behalf. This will also make recertification much easier if the five years’ worth of financial records are already available and ready to be submitted. Medicaid will retroactively pay benefits for 3 months prior to the application date. In other words, if an individual is eligible for Medicaid coverage as of April 1, 2020, he or she would have until July 31, 2020 to submit the application for April 1st coverage.
The April 2, 2020 GIS also states that individuals who already receive Medicaid coverage and are due to recertify in March, April, May, or June will automatically have their coverage extended for 12 months and will not be required to submit any documentation in order to renew their benefits.
While this self-attestation period will surely streamline the Medicaid application process and allow for faster turnaround times and approvals, it is essential that applicants and/or their attorneys ensure the application is complete and an accurate representation of the applicant’s resources. Otherwise, the applicant may face severe financial penalties once this period ends and it is time to recertify.