New York's 30-Month Medicaid Lookback: Awaiting Federal Approval

New York's 30-month Medicaid lookback for community-based long-term care was written into state law in 2020, but the statute conditions it on federal approval, and that approval has not been granted. As of July 30, 2026, the federal Centers for Medicare & Medicaid Services (CMS) still listed New York's request as a pending application.1,2

What that does not mean is that you can safely give assets away and apply for home care next month. Brevy could not confirm from any state or federal source how local districts are treating community transfers right now, and New York's own statutory change says the transfer rules for community-based long-term care are effective October 1, 2020. Before you make any gift or transfer, confirm the current rules with your local district or a New York elder-law attorney.3

This guide explains what the look-back was designed to do, why it has stalled, what is actually established about its status, what would change if it took effect, and how to weigh acting now against waiting.

Key Takeaways

• The 30-month look-back is conditioned on federal approval that has not been granted. New York Social Services Law Section 366(5) makes the 30-month period for a non-institutionalized applicant expressly "subject to federal approval," and the state must obtain CMS approval of a Section 1115 waiver amendment and a State Plan Amendment.1
• CMS still lists the request as pending. On the CMS Section 1115 demonstration record for New York's Medicaid Redesign Team demonstration, the community-based long-term care (CBLTC) amendment request appeared as a "Pending Application" as of July 30, 2026.2
• Do not treat that as a green light to make gifts. Brevy could not verify from a federal or state source how community transfers are being treated in practice today. Confirm with your local district or an elder-law attorney before transferring anything.3
• The 60-month federal look-back for nursing-home Medicaid is fully in effect. It applies to asset disposals made on or after February 8, 2006, and nothing about the community look-back's status touches it.3
• The community look-back was authorized by Part DD of Chapter 56 of the Laws of 2020 (the Medicaid Redesign Team II legislation), codified at Social Services Law Section 366(5), and reaches only transfers made on or after October 1, 2020.1
• When enforced, the look-back will phase in. New York proposed a modified phase-in, meaning a full 30-month retroactive review would not apply at the outset.1

What the New York 30-Month Medicaid Lookback Was Supposed to Do

To see why this matters, start with what it was built to change.

Before the 2020 statutory change, New York did not apply a transfer look-back to community-based long-term care. Applicants for home care, Managed Long Term Care (MLTC) plans, and personal care services were not subject to the transfer-of-assets rules that federal law lets states impose on non-institutionalized applicants. The federal 60-month look-back for nursing-home Medicaid, by contrast, has applied to disposals made on or after February 8, 2006.1,3

In 2020, as part of the Medicaid Redesign Team II reform package, the Legislature enacted Part DD of Chapter 56 of the Laws of 2020, and the New York State Department of Health (NYS DOH) began seeking federal approval to apply a 30-month look-back to applicants for community-based long-term care. The services covered include home care, Managed Long Term Care, personal care services, the Consumer Directed Personal Assistance Program (CDPAP), certified home health agency services, adult day health care, the Assisted Living Program, limited licensed home care, and private duty nursing. Under the state's April 2, 2020 statutory change, the transfer-of-assets rules for these services are stated to be effective October 1, 2020.1

How the 30-month design differs from the federal 60-month look-back:

1. Length. New York sought approval for a 30-month look-back rather than the 60-month federal default.
2. Phase-in. The state proposed a modified phase-in, meaning a full 30-month retroactive review would not be applied at the outset.
3. Scrutiny window. The earliest reviewable gifts are those made on or after October 1, 2020. Gifts before that date are never reachable.
4. Scope. Only applicants for community-based long-term care are affected. Institutional and nursing-home Medicaid continues to use the federal 60-month look-back.

Why It Has Not Taken Effect

New York originally intended to implement the amendment effective January 1, 2021. It did not, and the state later stated a different date.1

Federal Maintenance-of-Effort Restrictions

During the COVID-19 response, federal law conditioned enhanced Medicaid funding on states agreeing not to impose new eligibility restrictions, a rule known as "Maintenance of Effort" (MOE). New York pointed specifically to the MOE requirements under Section 6008(b)(1) of the Families First Coronavirus Response Act (FFCRA) and the Home and Community-Based Services requirements of the American Rescue Plan Act (ARPA), and stated that the earliest date it would seek implementation was March 31, 2024. That date passed without implementation.1

Pending Federal Approval

To apply the look-back, New York must obtain CMS approval of a Section 1115 waiver amendment and a State Plan Amendment adding the transfer-penalty rule for non-institutionalized applicants. The statute itself makes the 30-month period "subject to federal approval."1

That approval has not been granted. On the CMS Section 1115 demonstration record for New York's Medicaid Redesign Team demonstration, the CBLTC amendment request was still listed as a "Pending Application" as of July 30, 2026.2

What Is Actually Established About the Status

It is worth being precise here, because families make irreversible decisions on this question.

What is established. The 30-month period is conditioned on federal approval by the text of the statute. CMS had not granted that approval as of July 30, 2026, and continued to list the amendment request as pending. The separate federal 60-month look-back for nursing-home Medicaid remains fully in effect throughout.1,2,3

What is not established, and what we will not tell you. Brevy could not verify from any federal or state source how local social services districts are treating community-based transfers in practice today. New York's own April 2020 statutory change states that the transfer-of-assets rules for these services are effective October 1, 2020, which cuts against any blanket assurance that community transfers carry no consequence. So this guide does not tell you that a gift made today is penalty-free for a future home-care application. Confirm the current transfer rules with your local district or a New York elder-law attorney before making any gift or transfer.3

That is a narrower answer than most sources on this topic give you. It is the honest one, and the cost of the alternative falls on you rather than on us.

What the New York 30-Month Medicaid Lookback Would Do If Implemented

The Phase-In and the October 2020 Floor

New York proposed a modified phase-in: rather than applying a full 30-month retroactive review from day one, the state would begin with a shorter review window. Whatever the start date, the earliest gifts that can ever be reviewed are those made on or after October 1, 2020. Gifts before that date stay permanently out of reach.1

How a Transfer Penalty Is Calculated

New York converts a penalized transfer into months of ineligibility using a regional rate based on average private-pay nursing-home costs. The 2026 regional rates for calculating transfer penalty periods, per NYS DOH GIS 25 MA/14 effective January 1, 2026, are:3

As an illustration of the arithmetic, a $150,000 penalized transfer measured against the New York City rate of $15,282 would produce roughly a 9.8-month penalty period ($150,000 divided by $15,282).3

Exempt Transfers

New York has said that the exceptions to the federal transfer-of-assets rules, and the undue-hardship waiver, that apply under the Omnibus Budget Reconciliation Act of 1993 and the Deficit Reduction Act of 2005 would apply to these community transfers.1

Under 42 U.S.C. Section 1396p(c)(2), those federal exceptions include:4

• Transfers of any asset to a spouse, or to another person for the spouse's sole benefit.
• Transfers to a blind or permanently and totally disabled child, or to a trust for that child's sole benefit.
• Transfers of the home to a child under 21, or to a blind or permanently and totally disabled child of any age.
• Transfers to a trust established solely for the benefit of a disabled individual under 65 (a (d)(4)(A) trust).
• The sibling exemption. Transfer of the home to a sibling who has an equity interest in it and lived there for at least one year before the individual's institutionalization.
• The caregiver-child exemption. Transfer of the home to an adult child who lived there for at least two years immediately before the individual's institutionalization and, as determined by the state, provided care that kept the parent out of an institution.

A penalty is also excused on a satisfactory showing that the individual intended to dispose of the assets at fair market value, that the transfer was made exclusively for a purpose other than qualifying for Medicaid, or that all transferred assets have been returned. States must also maintain an undue-hardship waiver process.4

Separately, the penalty attaches only to assets disposed of "for less than fair market value." A sale or service contract in which the senior receives fair value, or other valuable consideration, is not a penalizable transfer.4

Pooled Income Trusts

A New York pooled income trust is a different mechanism from a transfer exemption, and its treatment deserves its own paragraph. Income directly diverted to, or received and then placed into, a certified disabled person's own exception trust is excluded when determining income eligibility under community rules, and only for income deposited in the same month it is received.4

Two limits matter enormously and are widely misstated elsewhere. First, if you are married and your Medicaid eligibility is determined under spousal-impoverishment budgeting with post-eligibility rules, which includes enrollment in a Medicaid Managed Long Term Care plan, then income you place in the trust will count in determining your eligibility. Second, for institutional Medicaid, a transfer of assets into such a trust by someone age 65 or older can itself trigger a transfer-penalty period, because the federal transfer exception covers only a trust established for the sole benefit of a disabled individual under 65.4

How It Compares to the Institutional 60-Month Look-Back

How New York Families Should Weigh the Decision

The practical question for most families: the rule is not approved, but it is also not repealed, so how should we plan?1

Scenario 1: A Senior Needs Home Care Now

If a New York senior needs home care or MLTC services now, apply now. Care needs do not wait on a waiver docket, and an application is processed under whatever rules are in force when it is filed.

What to ask about. When you apply, ask your local district directly whether it is reviewing past transfers on community-based long-term care applications, and get the answer before you assume one. That question costs you nothing and it is the only reliable way to learn the current practice in your county.3

Scenario 2: A Senior May Need Care Within a Few Years

This is the harder case, and the one driving most 2026 elder-law consultations. Deciding whether to move significant family assets while the rules are uncertain is genuinely stressful. You are weighing real money, and family relationships, against a federal decision the state does not control.

The honest framing is that this is a decision under uncertainty, not a window that is reliably open. A gift made today sits after the October 1, 2020 floor, so it is inside the range the look-back could eventually reach if the amendment is approved and applied. Whether it would actually be penalized depends on approval, on the phase-in New York adopts, and on how much time passes first. Nobody can tell you that today, including us.1,3

Other things that belong in the same conversation:

• Tax and basis consequences. Ask a tax professional what a lifetime gift does to gift-tax reporting and to the recipient's cost basis before you move an appreciated asset.
• Relationships. Once assets are gifted, they belong to the recipient, and that is not reversible because circumstances changed.
• The care path. If nursing-home care becomes likely, the federal 60-month look-back is fully active and a recent uncompensated transfer can create a penalty period.3

This is a decision to make with a New York elder-law attorney, not from a website.

Scenario 3: A Senior Likely to Need Nursing-Home Care

If the realistic path is nursing-home Medicaid, the community look-back's status is beside the point. The federal 60-month look-back for institutional Medicaid is fully active for disposals made on or after February 8, 2006, and transfer planning follows that longer five-year window.3

Scenario 4: Pooled Income Trust Users

If you use a pooled income trust to qualify for Community Medicaid on the income side, note the married-and-MLTC carve-out above: under spousal-impoverishment budgeting with post-eligibility rules, including MLTC enrollment, income placed in the trust counts toward eligibility. If that describes you, the trust is not doing what you may think it is doing, and that is worth checking with your district or attorney independently of anything to do with the look-back.4

What to Watch For

Two signals are the substantive ones, because they are the two conditions the statute and the state's own filing name:1,2

1. CMS approves the Section 1115 waiver amendment and the State Plan Amendment. This is the federal prerequisite, and the CMS demonstration record is where its status is posted. Until that entry stops reading as a pending application, the condition in the statute is unmet.
2. NYS DOH issues implementing guidance, typically a General Information System message (GIS) or an Administrative Directive, telling local districts how to apply the rule.

If either appears, families with planned transfers should consult a New York elder-law attorney promptly.

Common Pitfalls

1. Confusing the community look-back with the active 60-month nursing-home look-back. If the senior is likelier to enter a nursing home than to receive home care, the federal five-year look-back applies regardless of what happens with the community rule.3
2. Reading "not approved" as "no rules apply." The amendment is pending, not withdrawn, and New York's statutory change states an October 1, 2020 effective date for the community transfer rules. Get the current practice confirmed rather than inferred.1,3
3. Forgetting that gifts before October 1, 2020 are permanently out of reach.1
4. Failing to plan for the senior's actual care path. Many people who expect home care end up needing nursing-facility care. Plan for both.
5. Assuming a pooled income trust solves the income problem for a married MLTC enrollee. It does not.4
6. Self-help transfer planning without legal advice. The penalty math and the exemptions are technical, and the federal rules interact with New York's in ways that are hard to navigate alone.

Where to Get Help

Always confirm the current status and the current transfer rules with NYS DOH, your local district, or a New York elder-law attorney before making a major transfer.1,3

Learn More

Find personalized help navigating New York Medicaid at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.