Posts Tagged ‘look back period’

2013 Medicaid Eligibility Figures

New Medicaid Eligibility Criteria

The new Medicaid eligibility criteria for 2013 were recently announced. A Medicaid applicant/recipient is eligible with available resources of $14,400 up from $14,250 in 2012. Residences and retirement funds continue to be protected in certain circumstances under the new eligibility criteria. A spouse in the community who has an ill spouse in a nursing home or the Lombardi program may retain assets ranging between $74,820 and $115,920 and income of $2,898. The actual amount is determined by the value of the couple’s combined resources. Some community spouses may successfully argue for an even higher income or resource allowance.

If assets are gifted by the applicant or spouse within 5 years of seeking Medicaid nursing home benefits, a period of ineligibility will result if the gift is not exempt. In 2013, the value of the gift is divided by $12,034 in Nassau and Suffolk counties and $11,350 in New York City to determine the length of the period in which the applicant will be ineligible for Medicaid benefits. There is a proposal to extend the look back period to ten years. It may be a reason to consider making a plan sooner than later.
Penalty periods are not imposed on those who apply for Medicaid benefits at home. However if the home care recipient later requires nursing home care the prior gifts are an issue. Considerable planning can be done to address this concern.
New Medicaid Eligibility Criteria


Medicaid 5 Year Look Back in Full Effect February 2011

An applicant for institutional Medicaid benefits must submit financial documentation so that Medicaid can determine whether the applicant made non exempt transfers of assets prior to applying. Such transfers would result in a period of ineligibility for the applicant. For several years, an applicant needed to supply financial documentation for the prior 3 years. The Deficit Reduction Act of 2005 (DRA) changed the look back period to 5 years effective February, 2006.

This 5 year Medicaid look back period has been phased in slowly. For each month after the DRA was enacted, one month was added to the 3 year look back. Assets transferred before February, 2006 came under the 3 year rule.

Starting in February, 2011, the look back will be the full 5 years set out in the DRA.