Does Medicaid now look back seven years because of Obamacare?
That is what I heard. Tell me it is not true. I, only have records from three and a half years. Mom had dementia now and I didn't know her personal business .
The short answer is "No," the Medicaid lookback and penalty rules were not affected by the Affordable Care Act ("Obamacare"). The lookback period is still 5 years before the date you apply for Medicaid.
The Affordable Care Act (aka Obamacare) is about providing health insurance coverage. It is not an entitlement program but a health insurance product.
Medicaid is an entitlement program limited to those "at-need" both financially and medically for specific services. Medicaid is run by each state so what is required will depend on how your state administers Medicaid. For elderly Medicaid, since it is "at-need" you have to meet the strict asset & income limits set by your state and be able to provide documentation (the "look-back") for up to 5 years that no assets were transferred or gifted inappropriately. For my mom, it was a 3 year & 6 months of all financials that I had to provide for review. The state through their ability to look at county tax assessor records did a 5 yr review on mom's ownership on all real property (home, land, cars). Also the elder will have to have the medical history to show that they are "at-need" for skilled nursing services which is what a NH provides. Just being old, or needing help with their ADL's, or having memory issues may not be enough to meet the standard of needing skilled nursing care.
Some states do have waiver programs for AL (so they can be in AL rather than a NH) but these seem to be few & far between and the AL seem to want the elder to be on full private pay for 1 - 2 years prior. Some states also have community based programs which Medicaid pays for too.
Good in-depth answer igloo 572. Medicare is often confused with Medicaid. Briefly, Medicare is a federal government program. Medicaid is a state program. Each state has it's own requirements. Antiqfreq, I suggest you contact your Georgia Medicaid office to find out if your mother qualifies. Also, your local senior citizens club might have that information on hand.
I know what Medicare is for. I know what Medicaid is for. I only heard from a nurse today at her doctors office that now Medicaid in Georgia looks back seven years. Thanks everyone!
One more thing, which I asked; if I inky has financials for the time I have had her, what can I do about. She came with nothing as her sister got rid of it, along with alot of her money!
Medicaid will let YOU know when they review the application if there are any concerns. You may find yourself searching for insuarnace policy papers, etc. You can't be expected to tell them about anything you don't know, and if there was massive gifting to sister or some other non-exempt assets within the state's lookback period, there could be a penalty period where you will have to spend your/her own money. If it looks like you have any problems, you may want to involve an eldercare attorney or estate planner to help sort them out.
I would not be suprised if some states start looking back even longer, like 10 years...it is not the PPACA, but the fact that baby boomers care costs that end up coverable by Medicaid are skyrocketing and they can't afford to do it all..."they are not in the business of protecting children's inheritances" as it was explained by one of my advisors. Sorry it is so hard - years ago, it was not like this - and now some states even have filial responsbility laws that apply if a parent is impoverished, which can be an extreme burden though theoretically they are not meant to impoverish children and grandchildren, just to prevent inappropriate dumping of responsibilities.
10 Answers
Helpful Newest
First Oldest
First
Medicaid is an entitlement program limited to those "at-need" both financially and medically for specific services. Medicaid is run by each state so what is required will depend on how your state administers Medicaid. For elderly Medicaid, since it is "at-need" you have to meet the strict asset & income limits set by your state and be able to provide documentation (the "look-back") for up to 5 years that no assets were transferred or gifted inappropriately. For my mom, it was a 3 year & 6 months of all financials that I had to provide for review. The state through their ability to look at county tax assessor records did a 5 yr review on mom's ownership on all real property (home, land, cars). Also the elder will have to have the medical history to show that they are "at-need" for skilled nursing services which is what a NH provides. Just being old, or needing help with their ADL's, or having memory issues may not be enough to meet the standard of needing skilled nursing care.
Some states do have waiver programs for AL (so they can be in AL rather than a NH) but these seem to be few & far between and the AL seem to want the elder to be on full private pay for 1 - 2 years prior. Some states also have community based programs which Medicaid pays for too.
ADVERTISEMENT
I would not be suprised if some states start looking back even longer, like 10 years...it is not the PPACA, but the fact that baby boomers care costs that end up coverable by Medicaid are skyrocketing and they can't afford to do it all..."they are not in the business of protecting children's inheritances" as it was explained by one of my advisors. Sorry it is so hard - years ago, it was not like this - and now some states even have filial responsbility laws that apply if a parent is impoverished, which can be an extreme burden though theoretically they are not meant to impoverish children and grandchildren, just to prevent inappropriate dumping of responsibilities.