The Suffolk County, New York Department of Social Services denied the applicant’s Medicaid claim for nursing home benefits on the grounds that she transferred assets for less than fair market value during the applicable look-back period.
To be eligible for New York Medicaid, an individual must have no more than $14,550 in non-exempt resources. When determining Medicaid eligibility, an agency looks back for a period of 60 months immediately preceding the date the applicant was institutionalized and had applied for Medicaid, to determine if any asset transfers were made for less than fair market value.
If such a transfer was made during that period, the applicant is ineligible for Medicaid benefits for a period of time corresponding with the value of those assets. The presumption that such a transfer was made for the purpose of obtaining Medicaid eligibility can be rebutted by showing that the transfer was made exclusively for a purpose other than to qualify for medical assistance.
All the evidence at the fair hearing shows that the two subject monetary transfers were made when the applicant was living independently and several years before she required nursing home care. The transfers were made out of appreciation for her family, and still left her with enough resources to maintain herself for years.
If it were not for the unexpected loss of resources through theft, she would not have needed to apply for Medicaid. Therefore, the applicant met her burden of rebutting the presumption that the two subject transfers were motivated by the anticipation of a future need to qualify for medical assistance.
Although the gifts occurred during the 5-year look-back period, the New York Supreme Court, Appellate Division, First Department concluded that they were not disqualifying transfers because the applicant was able to rebut the presumption that they were made for purposes of qualifying for Medicaid.
Contact Robert Friedman, Attorney at 716-542-5444 if you have any Medicaid questions.