WHAT IS THE MEDICAID LOOK-BACK PERIOD?

Medicaid can pay for the nursing home care of individuals who meet certain income and asset requirements. However, if the applicant’s assets and income exceed these limits, he or she may not qualify for Medicaid assistance until the limits are met. Given the high cost of nursing home care, people sometimes try to give away their assets before applying for Medicaid in order to become eligible. Of course, state Medicaid agencies want to prevent this, so they require the applicant to disclose all financial transactions made in the last five years. (California is an exception and only requires disclosure of financial transactions made in the last 30 months.)


This five-year period is known as the “look-back period.” In essence, state Medicaid agencies are “looking back” for assets transferred at less than fair market value. If the state Medicaid agency determines that such a transfer was made, it will impose a “penalty period.” And what is the penalty? It is a period of time during which Medicaid will not pay the applicant’s nursing home bills. The penalty period is calculated by dividing the amount the applicant has transferred by the state’s average cost for private pay institutional care.


Any asset transfer can be scrutinized, regardless of size. Exceptions are not made for gifts to children or grandchildren, charitable donations, or other transfers that seem like “no big deal.” Similarly, informal payments to caregivers or loans to family members can raise red flags. In short, the applicant is considered guilty until proven innocent. The burden of proof lies with the applicant.


It is worth noting that transferring assets to certain recipients will not trigger a penalty period. These recipients can include a spouse or a trust for the sole benefit of a disabled or blind child. The applicant’s home can also be transferred to these recipients without penalty, as well as to all of the following individuals:


  • A child under the age of 21

  • A blind or disabled child

  • A “caretaker child” who resided in the home for two years or more before the applicant required institutional care, and whose care permitted the applicant to delay his or her move to a long-term care facility

  • A sibling who lived in the home during the year preceding the applicant's move to the institution and who has equity in the property


With proper planning it is possible to protect your assets against the transfer penalty. Even if you have already made asset transfers in the last five years and will be applying for Medicaid soon, we may still be able to protect a portion of your life savings. Contact us today for a complimentary analysis.



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