During the last 10 years, New York counties outside New York City cited the transfer of personal financial assets in denying an average of 7 percent of applications for Medicaid coverage of nursing home care.
New research from the Rockefeller Institute of Government, funded by the New York State Health Foundation and provided to the New York State Department of Health, also found a wide range of denial rates among the counties, with some denying close to half of applications examined in the study, while others denied less than 1 percent.
The study analyzed the role of asset transfers in county officials’ decisions to deny Medicaid coverage for nursing home care in the 57 counties outside of New York City. Fifty-two counties issued denials based on asset transfers. New York City was not included in the study because the city uses a separate data collection system.
“It is not clear why counties differ so much in their denials of Medicaid nursing facility services due to asset transfers,” said Ajita De, study author and research scientist at the Rockefeller Institute’s Health Policy Research Center. “Asset transfer denial rates may reflect how counties understand or implement the rules.”
Under federal eligibility rules, state and county officials can review financial records up to five years preceding a Medicaid application to determine whether individuals transferred assets to qualify for long-term care funding from Medicaid.
New York applies this requirement only to nursing-home care, while some other states also apply the rule to personal care and home care.
“We need to ensure both that all people entitled to Medicaid coverage receive it, and that taxpayer dollars are being spent prudently,” said David Sandman, senior vice president of the New York State Health Foundation. “Examining why some counties have denial rates that are four to five times higher than the statewide average is a call to action for program officials.”
Asset transfer is a practice whereby people with resources beyond Medicaid financial eligibility levels transfer all or a portion of their assets to become eligible for Medicaid. Various methods are used: establishing a trust, purchasing annuities and promissory notes, gifting assets, using personal service contracts with relatives to pay them for providing care and selling or transferring ownership of certain assets at less than fair market value.