Medicaid’s Look-Back Period Explained: Exceptions & Penalties

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page Reviewed / Updated – October 14, 2020 Joshua Iversen, President, Syzygy Financial LLC adept Reviewed By :


For an aged person to be eligible for nursing home care, assisted exist, adult foster care, or in-home care from Medicaid, they must have express income and assets. To prevent candidates from plainly giving away their money or resources to qualify for Medicaid, the federal government implemented the “ look-back time period ”. This is a determined period of meter prior to the person ’ mho lotion during which the Medicaid administer agency reviews all the fiscal transactions that the senior has made. If a transaction is found to be in violation of the look-back menstruation ’ sulfur rules, the applicant will be assessed a penalty. Penalties come in the form of a period of clock time that the applicant is made ineligible for Medicaid. This means they will not be able to receive caution services paid for by Medicaid for a certain number of months or, sometimes, even years .
A Medicaid applicant is penalized if assets ( money, homes, cars, artwork, etc. ) were gifted, transferred, or sold for less than the fairly market value. even payments to a health professional can be found in trespass of the look-back period if done colloquially, meaning no written agreement has been made. Please note, asset transfers by the applicant ’ sulfur spouse can besides affect the applicant and can result in a Medicaid punishment period for the applicant. The reason for this penalty period is that these assets could have been used to help cover the cost of long-run wish, had they not been gifted or transferred .
In 49 of the 50 states, the length of the look-back period is 5 years ( 60 months ). As of 2020, the one exception to this rule is California, which has a 2.5 year ( 30 calendar month ) look-back period. The look-back menstruation begins the date that one applies for Medicaid. For case, if an aged individual completes an application for Medicaid on July 15, 2018, the look-back period begins on that date and goes back 5 years to July 15, 2013 ( or in California, bet on to Jan. 15, 2015 )
It ’ second important to note, if a endowment or transfer was made prior to the look-back period, an individual will not receive a penalty .

Understanding Look-Back Penalties

The punishment for violating the Medicaid look-back is a period of time that one is made ineligible for Medicaid. This period of ineligibility, called the penalty menstruation, is determined based on the dollar come of transferred assets divided by either the average monthly private patient rate or daily secret patient rate of nursing home care in the submit in which the aged individual lives. ( This is called the punishment divisor or private wage rate, which increases each class with the increase in the price of nurse home concern ). Please note, there is no utmost penalty period .
Example #1
The department of state in which you reside has an average monthly price of $ 4,000 for nurse home concern and you gifted $ 60,000 during the look-back time period. This means you will be ineligible for Medicaid for 15 months. ( $ 60,000 gifted divided by $ 4,000 median monthly price = 15 months ) .
Example #2
Over the past five years, a grandma gave her granddaughter $ 8,000 / year, which equals $ 40,000 in trespass of the 5-year look-back period. The median casual cost for nursing home wish in her state is $ 200. This means the grandma will be ineligible for Medicaid for 200 days or approximately 6.5 months. ( $ 40,000 gifted divided by $ 200 average casual cost = 200 days / 6.5 months )
Example #3
Four years before applying for Medicaid, an aged charwoman sells her dwelling to her son for $ 250,000. During the review, it was discovered that the bonny market measure of the home at the clock time of sale was $ 350,000. She sold the home for $ 100,000 under its measure. The monthly monetary value of breastfeed home care in her state of matter is $ 5,000. frankincense, her penalty time period of ineligibility will be 20 months ( $ 100,000 / $ 5,000 = 20 months ) .
Example #4
For a time period of 8 years, a great aunt gave her capital niece a sum of $ 7,000 / class, totaling $ 56,000. Given the look-back period is just 5 years, the great aunt is only in trespass of the look-back menstruation for 5 of the 8 years. therefore, there is a union of $ 35,000 that falls within this punishment time frame. The median cost of private pay nurse home plate care in her state is $ 7,000 / calendar month. This means the bang-up aunt ’ south period of Medicaid ineligibility will be for 5 months ( $ 35,000 / $ 7,000 = 5 months ) .
The penalty period begins on the date that one becomes eligible for Medicaid, not the go steady that the transfer or endow resulting in punishment was made. For exercise, if you transferred your home to your child on August, 5th, 2019, but didn ’ thymine become eligible for Medicaid until March 16th, 2018, your period of ineligibility will begin on March, 16th, 2018 .

Look-Back Exceptions & Exemptions

fortunately, there are many exceptions to the rules and exemptions made for families in difficult situations. Under these exceptions, applicants are permitted to transfer assets to certain parties during the look-back time period without incurring a punishment. Less fortunately, these options are often confusing and unmanageable to implement without the expertness of a Medicaid plan professional .
An applicant is permitted to transfer up to $ 128,640 ( in 2020 ) to their spouse, given their spouse is not besides applying for long-run caution Medicaid and will continue to live independently in the residential district. Phrased differently, a non-applicant spouse is permitted to retain up to $ 128,640 of the pair ’ sulfur assets. This is referred to as the Community Spouse Resource Allowance ( CSRA ). The dollar sum changes on an annual basis, and there is some division to this exception dependant on one ’ sulfur state of residence. however, in reality, an applicant spouse can transfer inexhaustible assets to their non-applicant spouse without violating the look-back period. This is because, for Medicaid eligibility purposes, all assets of a married couple are considered jointly owned. ( Learn more here. ) however, a non-applicant spouse is not able to keep more than the assign CSRA .
Each state is either a 50 % state or a 100 % state of matter. This means the non-applicant spouse ( called the residential district spouse, the healthy spouse, or the well spouse ) is permitted to retain up to either 50 % or 100 % of the copulate ’ south assets, up to the allowable $ 128,640. The remaining assets must be “ spent down ” until the individual in motivation of long-run care meets the asset limit for Medicaid qualification. This can be done by paying off debt, making home modifications, or contributing towards the cost of retentive term concern. To clarify, view the mesa below .

2020 Medicaid Community Spouse Resource Allowance
Couples’ Combined Assets $50,000 $100,000 $150,000 $250,000 $500,000
Amount the “Community Spouse” keeps in a 50% State $25,000 $50,000 $75,000 $125,000 $128,640
Amount the “Community Spouse” keeps in a 100% State $50,000 $100,000 $128,640 $128,64 $128,640

Disabled Children
Applicants are permitted to transfer assets or establish trusts for disable children under the long time of 21. This includes children who are legally blind .
A family can be transferred to a sibling should that brother or sister own a dowry of the home ( have equity in the home ). And they must have resided in the home for at least one year before nursing home placement of the person in wonder .
Adult Children Caregivers
The “ Child Caregiver Exemption ” is designed for adult children who live with the Medicaid applicants ( their parents ) for a minimal of two years anterior to Medicaid application and serve as their basal caregivers. Under this exemption, the parent can transfer their home to their child without punishment. To learn more about this exemption, click here .
Debt Payments
Paying off debts during the Medicaid Look-back Period is besides excuse from rape. For case, paying off one ’ sulfur mortgage or base equity wrinkle of credit is a great way to turn liquid assets into exempt assets.

Transferring assets is a complicated matter and should not be done without first consulting a Medicaid technical .

common Mistakes and Violations

Since the federal politics permits U.S. citizens to gift money ( as of 2020, adenine much as $ 15,000 / class per recipient role ) via the estate of the realm and give tax exemption without paying tax on it, one may not realize that Medicaid does not consider the transaction to be exempt from the Medicaid look-back period. even gifts for particular occasions, such as holidays, weddings, and birthdays, may result in punishment by Medicaid. The like holds true for charitable donations. Further complicating matters is the fact that gifting rules change by state .
Lack of Documentation
even if one sells an asset and receives a prize equal to the carnival marketplace value, if they are ineffective to provide documentation of the transaction, they might be found in irreverence of the look-back period. This is of especial relevance for assets on which the government has a record, such as with boats, motorcycles, or vehicles via registrations .
Irrevocable Trusts
many people are under the err assumption that an irrevocable trust, sometimes referred to as a Medicaid Qualifying Trust, is exempt from the Medicaid look-back menstruation. however, this is not the case. A trust is a legal arrangement where an person ( the grantor ) transfers assets, and ownership, to a one-third party, besides called a regent, who then holds the assets for the named benefactive role. ( Assets that can be transferred via trusts include stocks, CDs, annuities, cash, and property. ) With an irrevocable trust, the grantor can not change or revoke the reliance as opposed to a revocable trust that can be changed. irrevocable trusts made during the look-back period are considered gifts. therefore, are in irreverence of the look-back period. however, irrevocable trusts made anterior to the look-back time period are not considered countable assets .
The condition, Medicaid Qualifying Trust, is inaccurately named and much violates Medicaid eligibility, thereby causing considerable confusion. One should take extra caution when hearing this phrase .

Look-Back Variations by State

Medicaid is a combined federal and submit program and, as such, so are the rules governing look-back periods. The penalty divisor measure varies by department of state. That is to say the dollar amount that Medicaid uses as the modal cost of nurse home care varies. Some states use a monthly average penalty divisor, while others use a casual average penalty divisor. Another mutant, for exemplar, is in the express of New York. The rules governing the transfer of assets under fair grocery store prize do not extend to family caution ( besides referred to as community care ). rather they entirely apply to nurse home concern. Some states may besides allow for little gift exceptions. For exemplify, Pennsylvania allows individuals to give up to $ 500 total / calendar month without being in misdemeanor of the Medicaid look-back time period. Please note, this does not hold true for all states .
It is strongly recommended that one confer with a Medicaid plan professional who understands the nuances between states .

application to Different Medicaid Programs

There are many unlike types of Medicaid programs. And the look-back period does not inevitably play a function as an eligibility agent in all of them. however, this page is merely refer with those Medicaid programs that are relevant to the aged. And the Medicaid look-back period applies to Medicaid long-run care services. This means that if one is in rape of the penalty period, there will be a time period of ineligibility for breastfeed home care, a well as services under Home and Community Based Services ( HCBS ) Waivers. Services and supports under HCBS Waivers may include adult day care/adult day health, in-home personal wish, suspension caution, etc. Having said that, punishment transfers may not extend to all states for community ( non-nursing home ) Medicaid, such as in New York .

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Strategies to Avoid Penalties

In order to avoid violating the Medicaid look-back time period and being penalized, there are strategies that are utilized to help families retain some of their assets or to help them gain Medicaid eligibility. however, it is highly recommend that one consult a professional Medicaid planner anterior to proceeding with any of the strategies that follow, as they can be extremely complex. Disqualifying a love one, unfortunately, is easily to do and unmanageable to rectify .

1) Caregiver Agreements

caregiver agreements are contracts that lay out the caregiving relationship between an aged individual and a caregiving relative or friend. They can besides be referred to as :

  • Life care agreements
  • Elder care contracts
  • Long-term care personal support services agreements

This formal agreement allows seniors to compensate their relative/friend for care provided and “ spend down ” assets without violating the Medicaid look-back menstruation. These contracts allow seniors to receive needed manage that Medicaid does not cover, while besides providing syndicate members or close friends with necessitate compensation. note, caregiver contracts may remain in effect even after the aged individual enters a breastfeed home facility, with the health professional helping as the advocate of the senior .
careful drafting of the contract ( which is broadly for the duration of the senior ’ second biography ) is imperative. It should include the date services began, caregiver responsibilities, whether it is shopping for essentials, providing exile, meal training, or personal care aid, and the hours a caregiver will work. In summation, the health professional must keep a log of duties performed, the hours worked each day, and maintain written invoices for the services .
The contract needs to state the amount of recompense ( which must be reasonable for the duties provided ) the health professional will receive in hark back for duties / services provided. The payment for a health professional agreement is sometimes paid in advance. therefore, when this is the case, the calculation must be figured based on a reasonable animation anticipation. When the elder passes away, Medicaid requires any remaining ( unearned ) compensation to be paid to them. Read more about health professional agreements .

2) Medicaid Exempt Annuities

Annuities, besides referred to as Medicaid Annuities or Medicaid Compliant Annuities, are a common way to avoid violating the Medicaid look-back time period. With an annuity, an individual pays a collocate total in cash. In revert they or their spouse receives monthly payments for the duration of that person ’ s life or for a adjust number of years. Annuities are Medicaid compliant because they turn assets into income, thereby lowering the assets the Medicaid candidate has to an amount below the Medicaid eligibility limit. Purchasing an annuity during the look-back period is not in irreverence of Medicaid ’ sulfur rules. Having said that, each state has slightly different rules with regards to Medicaid annuities and their beneficiaries. And there is no deficit of annuity salespersons. however, they may not be well informed about the Medicaid submission of their products. Proceed with caution .
Deferred annuities, which mean the investor chooses to delay payments until a assign period of time, are considered assets that can be used toward the price of long-run caution. consequently, they can not be used as a scheme to avoid violating the look-back rule .

3) Irrevocable Funeral Trusts

With irrevocable funeral Trusts, a specific sum of money, which is limited by state, is set aside for the sole purpose of funeral and burial costs. This not alone helps applicants “ spend down ” excess assets without violating Medicaid ’ s look-back period, it besides provides peace of mind knowing that these expenses are already covered. An irrevocable funeral trust can be purchased for both the applicant and their spouse. Learn more about irrevocable funeral trusts here .

4) Undue Hardship Waiver

Via an Undue Hardship Waiver, the Medicaid Penalty Period can be waived. For case, if an individual has violated the Medicaid look-back period but will be without basic needs, such as food and shelter, due to this violation, one can request this release. however, one must first exhaust all methods of recovering the assets that were transferred. This includes legal options. It ’ second important to note that it is very difficult to be granted an undue Hardship Waiver .

5) Recuperation of Assets 

If a Medicaid applicant has transferred assets under fair market value during Medicaid ’ s look-back menstruation and those assets can be recuperated, the punishment menstruation will be reconsidered evening after the institution of the penalty period. In some states, this might mean all assets transferred to all people, which in some cases are multiple assets and several people. That said, if some assets, but not all the assets, are recuperated, the entire penalty menstruation is however carried out. however, in other states, fond convalescence might shorten the menstruation of Medicaid ineligibility. Please bill that returned assets will put an applicant over the asset specify. But these excess assets can be used to pay for long-run care and the applicant can then reapply .

6) Professional Medicaid Planning Assistance

The Medicaid look-back period is a very serious and complicate matter. The best way to avoid violating this period and receiving a penalty of Medicaid ineligibility is to consult a Medicaid planner before gifting or transferring any assets. A Medicaid planner can besides offer aid if you have violated the look-back time period. One can learn more or be connected with a Medicaid planner here .

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