The Five-Year Look Back

  |  December 3, 2015

What is the five-year look back period?

When people think about Medicaid, the first thing that usually comes to mind is the “five-year look back period.” While this is a familiar phrase, what it encompasses is usually more of a mystery to people.

What is the five-year look back?

The five-year look back is the period of time for which you must produce all of your financial records to your county’s department of social services (“DSS”) for their review.  Financial records include statements from your IRA, 401k, life insurance, annuity, brokerage and bank accounts, as well as proof of any bonds and copies of your income tax returns.  This review also includes any account(s) that you might have closed during the five-year time period (because keep in mind, the financial institution probably issued a 1099 sometime within the past five years, which is reflected on your income tax returns). These financial records are required from both the Medicaid applicant and his/her spouse, if applicable.

Does the five-year look back apply to all Medicaid cases?

The five-year look back is presently only required for Medicaid Nursing Home applications; it does not apply to Medicaid home-care applications.  While many people prefer to remain in their home as they age, the five-year look back should be kept in the back of your mind as you age.

When does the five-year look back start?

The five-year look back period is an ever moving point.   Each time you make a transfer (discussed below), there is a five-year timeline before that particular transfer is outside of the purview of DSS.  Further, it is not until an individual is admitted into a Nursing Home that we know the exact five-year period for that individual.

Why is there a five-year look back period?

Why does DSS need all of my financial information from the past five years?  Since Medicaid is a means-based government program (one that requires the applicant to meet certain income and resource standards) DSS must review the applicant (and spouse’s) financial records to ensure that the applicant does, in fact, meet the required standards.

What does DSS look for?

DSS wants to make sure that the applicant did not dispose of assets to family members (or to a trust), rather than use those assets for his/her care. DSS is looking for circumstances where you gave money away.  For example: If you paid for the reconstruction of your kitchen, you did not give your money away—that was a purchase.  DSS will want to see proof of the purchase, but it not considered a “transfer” or a “gift.”  However, if you paid for your granddaughter’s college tuition or paid off your son’s car loan, those are considered gifts/transfers for the purposes of the five-year look back period and DSS takes a very narrow position when it comes to these types of gifts.  If the gift occurred within the past five years, DSS will likely determine that it was done for the purpose of qualifying for Medicaid and will institute a penalty on the applicant.

Are there exceptions to the transfer rule?

Of course, there are exceptions to this rule.  For example, what if you moved money from your bank account, into your spouse’s account in order to pay the bills?  This type of transaction between spouses is a transfer that is not subject to the transfer penalty because transfers between spouses are one of the exceptions to the gift/transfer rule.  In addition, a transfer to a blind or disabled child is also not considered a disqualifying transfer.

So we recommend that you plan for the five years and hope that it never becomes an issue.





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