Elder Care Planning

Medicaid Look Back Provision

A Medicaid Lookback is extremely important when it comes to financial eligibility for Medicaid. The purpose of the Medicaid Lookback period is to give the Medicaid agency an opportunity to heck all financial transactions that occurred on the elder’s behalf.This means that if a lookback is required for a specific service, then the medicaid applicant is required to present all financial records requested during the lookback period. The typical lookback period for nursing homes is estimated to be around 5 years. The Human Resource Administration (HRA) is responsible for reviewing the lookback documents and checking the transfer of assets, especially in identifying transfers for less than the fair market value by the applicant or spouse during this period. Based on current NY State laws, nursing homes are required to do a lookback to admit applicants for care. The lookback will be required for people who are in the Medicaid Buy-In for Working People with Disabilities. Applicants who have an income that is below the income bracket of $895 as a single individual or $1304 for a couple will not be required to partake in the lookback process. The Lookback changes were expected to take place in October of 2020, however due to the current Covid-19 pandemic, these changes cannot occur prior to April1st of 2021. It can feel overwhelming with all of the sudden changes bound to take place, especially considering the pandemic situation. The best way to prepare for these changes is to obtain as much information as possible and obtain a clear understanding of how these changes will directly impact you and your loved ones.

Medicaid Lookback 2020-2021

Consequences associated with failure to follow the outlined Medicaid Lookback rules result in penalties. Such penalties pertain to the gifting or transfer of assets usually in the form of real estate sales below the market price value. These penalties indicate that the individual becomes ineligible for Medicaid during a certain time frame, thus Medicaid will refuse to pay for any medical services. The period of time these penalties apply to depends on the quantitative value of money transferred or gifted, yet most penalties tend to last for numerous months. The laws for Medicaid Lookback are extremely specific, as an action such as payments to a caregiver without a written agreement can be flagged by the Medicaid agency. These penalties are put in place in the effort to prevent individuals from spending their assets on the costs of long-term care. The typical length of a Lookback period is 5 years and begins the very moment that an individual applies for Medicaid. This Lookback period specifically pertains to individuals in search of a nursing home or a care community. Luckily, there are certain exceptions for the Lookback period, which the Elder Care Attorney will make you well aware of.

Exceptions for the Lookback are made with the intent to help families in need. During this time, one is eligible in transferring their assets without receiving the consequence of a penalty. With the guidance of an esteemed Elder Care Attorney, the procedure concerning Lookback exceptions can be simplified and highly applicable to many families. According to the 2020 guidelines, one is allowed to transfer up to approximately $129,000 to a spouse, as long as their spouse is not also applying for Medicaid eligibility. This specific transfer of assets to a spouse is titled Community Spouse Resource Allowance, where the quantity of value that was allowed to be transferred depended on the specified value for each given year. In reality, the Medicaid applicant could transfer any sum of money to their spouse without breaking any set regulations, seeming as all of the combined assets of the couple are taken into consideration when it comes to Medicaid eligibility. The spouse cannot withhold a value of the money that goes over the value specified by the Elder Spouse Resource Allowance. This pertains to the new rules regarding Medicaid exceptions for the Lookback period.

There are various mistakes that can negatively impact Medicaid eligibility. However, these mistakes can be greatly reduced and even eliminated with the help of an experienced Elder Care Attorney, as the attorney will provide you with a specified plan of action based on your personal circumstances. A very common mistake is the belief that an Irrevocable Trust will be exempted from the Medicaid Lookback period, however this is an extremely false misconception. With an Irrevocable Trust in place the grantor does not have the opportunity to foster changes within the trust. If an IrrevocableTrust is created during the Lookback period, then they will be considered as gifts. Granted it is valued as a gift, the individual becomes eligible for Medicaid qualification for a certain time period, as according to the penalty consequences. Another common error is associated with the process of gift giving during the Medicaid Lookback period. Gifting money through the form of an estate without paying the designated tax amount money will have a negative impact on one’s Medicaid eligibility. These gifts do not have to only take the form of estates, rather they can pertain to special events and holiday gift giving as well. AN esteemed Elder Care Attorney will provide guidance to refrain from potential mistakes that could jeopardize one’s Medicaid eligibility.

There are a variety of methods to ensure that one does not incur a penalty as a consequence of improper actions related to Medicaid. One such method is the creation and use of a Caregiver Agreement also known as an Elder Care Contract. This gives elderly the opportunity to obtain care that was not covered by Medicaid, while providing a family member with monetary compensation for caring for them. The contract will include the specific quantitative value of compensation, which can be paid in advance or paid during care based on personal preference. Another method is the Undue Hardship Waiver, which is utilized during the Lookback period and serves to ensure that seniors are able to obtain their daily needs. This can be put into place once the individual makes the effort to try and recover the assets that were transferred and caused the penalty in the first place. The final method is the recuperation of assets that were transferred below the fair market value price range. This would have an influence on the length of the Lookback period and can change the amount of time designated within the penalty period. There are numerous potential methods in solving issues related to Medicaid eligibility.

The Elder Care Attorney will be sure to not only make you and your loved ones aware of all your options, but will also walk through the process and guide you for whichever process you select. For Medicaid eligibility information please contact the Law Office of Inna Fershteyn at 718-333-2394 to best prepare for Medicaid eligibility changes and avoid penalties during the new Lookback provision that will begin as of April 2021.