How long is Medicaid's look back period?

4 answers | Last updated: Sep 16, 2017
A fellow caregiver asked...

How far back does Medicaid look at Mother's trasfer of assets? We have been told 3 years, 5 years, and 10 years.

Expert Answers

It's either 3 years or 5 years, depending on when the transfers were made. The Medicaid "look-back" rules have to do with whether giving away assets, or transferring them for less than full value, will disqualify your mother from Medicaid coverage of her nursing home costs. (The rule would not apply to Medicaid coverage of her regular medical costs or of home care.)

Here the rules. To qualify for Medicaid nursing home coverage, your mother must have very low income and assets. Medicaid will look at any transfer of assets she's made in the previous years. If assets have been given away, or transferred for less than full value, during a "look-back" period before applying for Medicaid, your mother may be ineligible for Medicaid nursing home coverage for some period of time. The length of ineligibility is calculated by taking the value of the transferred asset and dividing it by the average monthly nursing facility cost in the state where your mother lives.

The look-back periods are different in length, and in severity of penalty, depending on when the gift or transfer was made:
• For gifts or transfers she made before February 8, 2006, the look-back period is 36 months from the date your mother applies for Medicaid nursing home coverage. If her gift or transfer falls within this time, her period of ineligibility begins to run from the date of the transfer.
• For gifts or transfers your mother made on or after February 8, 2006, the rules are much tougher. The look-back period for transfers made after this date is 60 months from the date of your mother's Medicaid application. And if a less-than-full-value transfer falls within this time, the period of ineligibility begins from the date of your mother's application for Medicaid coverage (NOT from the date of the transfer, as under the earlier rule).

For more explanation of these rules, and for some possible ways to protect some assets, take a look at the web page Elder Law Answers.

Community Answers

A fellow caregiver answered...

Yes, the Sanction penalty period now has changed. it now applies to when the person actually applies for medicaid - usually when they have been admitted. This means now, property transfers, gifts, and cash withdrawals done over the previous five years, create a penalty that applies now. In our State, $5,000 of "transferred" property triggers a one month sanction period of no payment. Some people think that this means that Medicaid won't pay the first $5,000 of the Nursing home bill. It actually means they won't pay the 1st month- which can be much much worse. $5,000 may be the average cost of care, but in my husband's skilled facility, the costs are over $20,000 per month. So, a one month penalty can actually leave the family with a very high un-payable bill. This is particularly hard on middle aged persons who have an unexpected stroke or disability.

Mamoogins answered...

It is also my understanding that you must also "spend down" monies such as IRA's or other investments, prior to becoming eligible for medicaid. So how does this effect the "look back" period?

A fellow caregiver answered...

Is the look back time frame the same in each state ?? I live in MN. Is it 5 yrs.??