The Five-Year Look Back, pertains to an application for Medicaid.  Medicaid is a Federal program that is administered by the individual states. Its purpose is to pay the medical bills of the indigent. Medicaid also pays Five Year Look Back determinationfor nursing home care when an elder has less than $2,000.00. Medicare does not pay for nursing home care.

Medicaid and the Five-Year Look Back

 When one applies for Medicaid benefits, Medicaid will look at all financial records from the prior five years. All of the bank statements, investment account statements, real estate sale information, and the like will be reviewed. This is called the “Five-Year Look Back”. Medicaid will examine these documents and transactions to determine if any assets were gifted to others, for the purpose of deliberately impoverishing the elder to qualify for benefits. Some county social service offices will review everything over $500.00, others everything over $1,000.00. If it appears that gifts were made, the applicant will be penalized.

What This Might Mean to You

Many times, children will ask a parent to transfer the house into their names, so that “the State doesn’t take it”.  Aside from a capital gains issue, if this transfer is made within the five-year look back, the parent will be denied benefits for many months, maybe years. And, by the way, the State never “takes” the house.

Another issue is the current $14,000.00 gift tax exclusion. One can gift up to $14,000.00 to as many people as they wish, during the calendar year, and not have to file a federal gift tax return. While this is true for purposes of the gift tax, it does not mean that an elder facing nursing home care can make these gifts during the five year look-back period and then claim poverty. The elder will be disqualified from benefits for some period of months.

Penalty Divisor

Once the Medicaid office determines the total amount of improper transfers, it will divide the total by the Penalty Divisor. The Divisor changes from year to year. It is supposed to represent the average cost of nursing home care in the state. In 2017, the Divisor is $423.95 per day, or $12,895.15 per month. By this formula, Medicaid will determine the number of penalty months. The penalty will begin when the elder is otherwise eligible for Medicaid, and it will run for the number of months determined. During this time, the elder has no money to pay for his or her care, and other sources, such as the family members who received the gifts, will have to pay. If this does not happen, someone may need to take the elder home and provide care or apply for a hardship waiver under appropriate circumstances. This is the importance of the five-year look back period.

Permitted Transfers

There are some transfers permitted by Medicaid during the five-year look back period.  But these permitted transfers are few and are very fact and time sensitive. In order to properly make these transfers, you will need the help of a qualified elder law attorney. Law Offices of Robert J. Shanahan, Jr. has been meeting with clients and walking them through the Medicaid minefield for decades. If you have an elder who has nursing home care in their future, it is important that you meet with us as soon as possible.