5 Year Look-Back

What does the 5 year Look-Back truly mean?

When a person applies for Medicaid nursing home medical assistance he/she must surrender five (5) years of bank statements. That does not mean the person applying will be disqualified for five (5) years. It only means they need to surrender bank statements.

If within the five (5) years, prior to entering the nursing home, the applicant transferred, gave or even gifted any assets, Medicaid will impose a disqualification period. How does this disqualification period calculated?

Medicaid uses a chart called Nursing Home Regional Rate and each County in NY is assigned a different rate. In 2016 a resident of any borough in NYC who transfers $12,029 (the 2016 NYC Regional Rate) he/she will be disqualified one month of nursing home care. This means Medicaid will not pay their nursing home expenses the first month. Lets say the applicant transferred $120,290 he/she will be disqualified for ten (10) months before Medicaid will start paying the nursing home.

Of course there are various tools to reduce the disqualification period, but for this blog we wanted to reduce the fear regarding the five (5) year look-back period – it does not necessarily mean five years of disqualification.