What is the Medicaid Look-Back Period?

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Safe Harbor Law Firm

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Jul 21, 2023

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Florida - Southwest

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Medicaid can pay for the long-term institutional 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 long-term 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 the applicant will be deemed ineligible for Medicaid. 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 include a spouse (or a transfer to someone else if it is for the benefit of the spouse); a trust for the sole benefit of a disabled or blind child; and a trust for the sole benefit of a disabled individual under age 65. 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.

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If you have additional questions or concerns regarding the Medicaid look-back period, contact the experienced Florida Medicaid planning attorney at Safe Harbor Law Firm by calling (239) 317-3116 to schedule an appointment.

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Safe Harbor Law Firm

Elder Law 28901 Trails Edge Blvd, Suite 204, Bonita Springs, Florida, 34134

At Safe Harbor Law Firm (formally known as Buff Law Firm PLLC), we focus on estate planning, elder law, and closely related practice areas. Our true focus, however, is helping families plan for and take control of their future. This can involve:Ensuring your assets will go to the people you want, when you want, in the manner you want after you pass awayPreparing for the possibility that you or your spouse will need expensive long-term careand helping you find ways to pay for itEnsuring that people you trust have the authority to make financial and medical decisions on your behalf in the event of incapacityProtecting your assets and those of your heirs against threats such as creditors, lawsuits, divorce, the high cost of long-term care, and moreGuiding your loved ones through the probate and/or trust administration processSafe Harbor Law Firm has helped families from all walks of life find solutions to challenges like these and many more. We welcome the opportunity to do the same for you. Ultimately, our goal is to help you enjoy the peace of mind that comes from having a plan in place for the future. We invite you to contact us for a personal meeting to discuss your particular needs and goals.