Paying for care

What is look-back period?

The look-back period is the window, five years in most states, during which Medicaid reviews any assets a person gave away or sold below value before applying.

By Emmanuel Akyeam · Updated

Transfers in that window can trigger a penalty period during which Medicaid will not pay, calculated from the value transferred. Gifts to children, adding a name to a deed, and selling a house cheaply to a relative all count.

This is the main reason families are told to see an elder law attorney before moving money.

Why it matters

A well-meant gift five years ago can delay Medicaid coverage at the moment it is needed most.

Questions people ask

What is the look-back period for Medicaid?

The look-back period is the 60 months, or five years, before a Medicaid application for long-term care that the state reviews for gifts or transfers of assets for less than fair market value. The Centers for Medicare and Medicaid Services says the Deficit Reduction Act of 2005 set this length. Cash gifts to children or transferring ownership of a home are examples. Talk with an elder law attorney.

Does the look-back period apply to nursing home care?

Yes. The look-back applies when someone applies for Medicaid to cover long-term care, including nursing home care. The Centers for Medicare and Medicaid Services says states check whether the applicant or their spouse transferred assets for less than fair market value in the previous 60 months. The Alzheimer's Association warns that strict laws govern giving away assets, so get legal advice before transferring any property or money.

What is the Medicaid look-back penalty?

The penalty is a period during which Medicaid will not pay for long-term care, triggered by assets given away for less than fair market value during the look-back. The Centers for Medicare and Medicaid Services says it starts on the later of the transfer date or the date the person enters a nursing home and would otherwise qualify. States can waive it for undue hardship, such as threats to health or life.

Is there a look-back period for Medicare?

The look-back period is a Medicaid rule for long-term care, described by the Centers for Medicare and Medicaid Services as part of Medicaid's transfer of assets rules. Medicare is different: Medicare.gov describes it as federal health insurance for anyone 65 and older, and some younger people with disabilities, rather than a program based on income and assets. Asset transfers matter when applying for Medicaid.

Is the Medicaid look-back period different by state?

Federal law, the Deficit Reduction Act of 2005, set the look-back at 60 months, and each state carries out the review when someone applies for long-term care, according to the Centers for Medicare and Medicaid Services. Medicaid's other eligibility rules differ in each state, Medicare.gov notes. Because state practice and exceptions vary, check with your state Medicaid office or an elder law attorney before moving any assets.

Sources

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