What You Need to Know About the Medicaid Look-Back Rule

smiling elderly person

For many people, Medicaid planning offers an opportunity to help pay for long-term healthcare costs without needing to pay out of pocket. Unfortunately, something known as the Medicaid “look-back” rule can interfere, potentially limiting your ability to access Medicaid benefits. But what exactly is the Medicaid look-back rule, and how could it potentially impact you?

Explaining the Medicaid Look-Back Rule

The Medicaid look-back rule determines how your personal assets are calculated for the purposes of qualifying for Medicaid. Put simply, the rule does not only look at how much in assets you currently have, but also how much you had going back a certain amount of time. In New York, the look-back period is 60 months for chronic care benefits needed for a nursing A new 30 month look-back period for community-based benefits which pays for nursing aide to the home is set to begin in March 2024.

What the Look-Back Rule Does

The look-back rule is meant to deal with situations where people attempt to get around the Medicaid limits by transferring their assets out of their possession. This includes gifting their assets to family members, as well as placing their assets in a Medicaid trust. If you attempt to apply for Medicaid benefits while you are within look-back window, you may be subjected to a long penalty period on those assets that were transferred out of your possession. The penalty period refers to the amount of months that Medicaid will not pay such benefits.

How It Could Impact You

If you do not plan far enough ahead before applying for Medicaid long-term or community care benefits and get caught within the look-back period, your application for Medicaid may be denied if you are above the limits or you may be subject to a penalty period for recent transfers. If that happens, you may find yourself paying for your care out of pocket, meaning you will need to deplete your account or sell your assets to pay for care. Depending on the nature and extent of your medical needs, this could be financially disastrous.

What You Can Do

If you believe you may need to apply for Medicaid benefits to help pay for a nursing home or for aides to the home, you should consider Medicaid planning as soon as possible. It can help protect your personal finances from exorbitant healthcare costs, while also helping you to plan your estate. However, to know what may work best for your needs, you should speak to a lawyer with experience handling estate law matters.

The Virdone Law Firm is here to assist Long Island families with all of their family law and estate law issues. We pride ourselves on providing unparalleled legal representation with a foundation in personalized client service. To learn more or schedule a consultation at our Westbury office, give us a call at (516) 570 - 3875, or visit our contact page.

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