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What is the Medicaid look back period and how can it affect you?

| Jun 7, 2021 | Medicaid |

You may have cared for a senior loved one for many years, but eventually the task becomes too burdensome, and you may find that the best care option for your loved one is to enter a nursing home. It is no secret that nursing home care in Kentucky is prohibitively expensive. Most people plan on relying on Medicaid benefits to afford a stay in a nursing home, so it is important to have a general understanding of when and how a person can become eligible for Medicaid.

When am I eligible for Medicaid?

In general, a person becomes eligible for Medicaid based on their modified adjusted gross income (MAGI). This looks at a person’s sources of income but does not take into consideration a person’s assets. However, MAGI Medicaid benefits cannot be used to pay for a long-term stay in a nursing home. For this a person would need to be eligible for long-term services and supports (LTSS), and eligibility for LTSS does consider a person’s assets. It may be tempting to spend down one’s assets or give them away in order to be eligible for Medicaid. However, this could subject one to the Medicaid look back period.

What is the Medicaid look back period?

To avoid having people sell or give away resources that could have been used to pay for a nursing home stay the Centers for Medicare and Medicaid Services has established what is called the Medicaid look back period. This period starts the day a senior applies for Medicaid and goes back five years from there. A Medicaid applicant’s financial transactions during this time period will be reviewed to see if any assets were given away or sold for less than their fair market value. If such a violation occurs the applicant will be subject to a period of ineligibility for Medicaid benefits, which will delay how long a person must wait for approval.

Learn more about the Medicaid look back period

Being penalized for violating the Medicaid look back period can be problematic for those who need immediate nursing home care. This post is for educational purposes only and does not contain legal advice. Our firm’s webpage on the Medicaid look back period may be a good resource for those who want to learn more about this topic.