Changes to New York Medicaid in 2025: What Families Need to Know

If you or a loved one relies on Medicaid for home care in New York, pay close attention, big changes have just been enacted! At Sammartino & Sultan Law Group, we’re here to break down what’s new, what it means for you, and how to plan ahead.

What’s Changing?

1. The “Three ADL” Rule

Starting September 1, 2025, getting Medicaid-funded home care just got tougher. Now, most applicants will have to show that they need hands-on help with at least three Activities of Daily Living (ADLs) like bathing, dressing, toileting, eating, or getting around. (It used to be just two!) This means if you only need assistance with one or two ADLs, you may not qualify under the new rule.

2. Special Exception for Cognitive Impairments 

If someone has a diagnosis like Alzheimer’s or another kind of dementia, the requirement is a little different: they now must need supervision for at least two ADLs (up from just one). This still recognizes the unique needs of people with memory or cognitive challenges, but it is a more difficult standard than before.

3. The 30-Month Look Back

We all know about the five-year (60-month) “look back” for nursing home Medicaid, but until now, there’s been no look back for home care. That’s about to change. Sometime soon, New York will implement a 30-month look back for Community Medicaid home care. Any transfer of assets or gifts made in the 30 months before applying could penalize you or delay getting care.

4. Current Recipients: “Grandfathered In” 

Here’s some good news: If you’re already receiving Medicaid home care before September 1, 2025, you won’t lose your eligibility because of these new rules, you’ll be “grandfathered in” under the old standards. But anyone applying after that date needs to meet the new, tougher criteria.

What Does This Mean for Families?

• More People May Be Denied Care: If you’re on the edge of eligibility now, these new rules could put Medicaid home care out of reach.

• Families May Have to Fill the Gap: If Medicaid won’t cover care, families may need to step up and provide more help themselves or find other ways to pay for care.

• Planning Is More Important Than Ever: With a stricter ADL standard and a look back period on the horizon, starting your Medicaid planning early is critical. Don’t wait until a crisis hits!

What Should You Do Next?

If you think your family might need Medicaid home care in the future, especially if you’re close to meeting the new ADL standards, get your application in as soon as possible. Early planning can mean the difference between qualifying for essential services and having to scramble for alternatives.

Have questions or want personal guidance? Our team at Sammartino & Sultan Law Group is here to help you make sense of the new rules and protect your loved ones.

Reach out today! Proactive steps now can save major headaches later!

About the Author

Christina has been practicing law in New York State, for over 7 years. She is a Pace University School of Law graduate. After passing the New York and New Jersey Bar Exams, she went on to work for several law firms with primary practice areas in Real Estate, Estate Planning, Estate Administrations, Guardianship proceedings under Article 81 of the Mental Hygiene Law, and Article 17A, Medicaid planning and applications. Christina is also certified as a Guardian, Court Evaluator, and Attorney for the AIP under Part 36 of the Rules of the Chief Judge.