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Explaining The Medicaid “Lookback” Period


The majority of nursing home residents in the U.S. receive some kind of Medicaid assistance to help cover the cost of care. However, in order to receive that assistance, Medicaid recipients must pass a means test – in other words, they must not have income or assets over a certain level. This threshold can be difficult to meet for some, particularly those with some assets – many in wealthier places like Westchester or Putnam County may be tempted to simply give away assets in order to qualify, but Medicaid’s “look-back” period exists to act as a deterrent to this kind of behavior.

Preventing Inappropriate Asset Transfers

The way Medicaid is structured means that it is a “last-resort” payer for nursing home costs, meaning that if someone has alternative ways of paying for care, they must exhaust them before Medicaid will step in. The Center for Medicare & Medicaid Services (CMS) observes a “look-back” period in which the program will investigate transactions to ensure that no assets have been disposed of simply to keep them out of CMS’ reach. Examples might include antiques or art gifted to family members at no cost, or selling property for significantly less than market value.

If any such transaction is discovered, the person who made it will face a penalty, which is a period in which they are ineligible for Medicaid benefits, usually for the length of time that selling the asset would have paid for. For example, if a person transferred an asset worth $12,000 and care for them costs $2,000 per month, they would be ineligible for Medicaid benefits for six months. There are exceptions to this general rule, but it is crucial not to assume that your transfer will fit into one without checking.

New York Is An Exception

Something that New York residents should be aware of with regard to Medicaid planning and the “look-back” period is that New York is a general exception to the rule. Most states have a 60-month (5 year) look-back period for both nursing home Medicaid and for ‘community’ Medicaid, which is the program in which state residents can receive in-home care. This begins on the day one applies for Medicaid benefits. New York has this period for nursing home Medicaid, but as of this writing, no look-back period currently exists for community Medicaid; a 30-month period is scheduled to be instituted no later than March 2024.

What this means is that for a short period of time, if you intend to seek community-based care, now may be the time to apply for it. This can be a difficult decision for some – but many find home-based care a more attractive choice if their health permits it. With no look-back period to worry about, you may be able to make more reasoned choices, particularly if you enlist the help of a legal professional in doing so.

Contact A Pleasantville Medicaid Planning Attorney

Making choices for end-of-life care can be intimidating and even frightening, particularly when there are strict requirements one must meet in order to receive it. You do not have to go through the process alone – a Westchester County elder law attorney from Meyer & Spencer, P.C. can help. Contact us today via our website, or on the phone, to schedule a consultation.




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