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devorej Asked November 2014

What is the dollar amount Medicaid targets in the five year look back period?

pamstegma Nov 2014
ALL of it, ALL the way through 2009 or farther in some states.

igloo572 Nov 2014
Medicaid is state run under an overall federal guideline. So just how your application & supporting documents are reviewed will vary by state. There seems to be no set standard.

For my Mom in TX, it was a 3 year & 6 mos review of all financials. Yes, 42 months of bank statements. Between those and insurance policies and property documents, my moms supporting was over 100 pages. In addition a letter was required from her bank as to the disposition of all CD, T bills etc closed or not renewed and where the proceeds went as well. . For us, the $ went into her main drawing account so the trail of $ was obvious. But had a CD of $5,678 been cashed out, there would have been a transfer penalty inquiry on the $. For my MIL, also in TX, there were ? on checks under $100 for transfer penalty - she wrote checks to her state paid aides to go & buy liquor for her when she was living in sub. housing. It needed to be established that the $ was not gifting.

I think they are looking for a pattern of spending that fits their income and assets. In order to financially qualify for Medicaid basically it's 2K in income & 2K in assets. Now for their Medicaid application, they have to provide their awards letters & banking details, so someone who gets $1,000 a mo income with 50K in savings 3 years ago & lives with family should have a pretty good nest egg that will need to be spent down & used for private pay for care before Medicaid will pay. If they don't, $$ has been probably transferred or gifted. They will have to show just where 48K in savings and the 36K in income just vanished to. If you get a transfer inquiry, you have a very tight timeframe to do this otherwise app will be declined. Medicaid will send you the decline letter & also the NH gets the letter. NH will expect family to sign off on a private pay contract in order for mom to stay there too.

But say its the same finances for an applicant who has a home & paid for home health care or other verifiable health expenses, it can make sense that they are now impoverished at 2K as $ has been spent on the home & care over the past 3 years to get to the point of being impoverished.

I would imagine that the states have a basic algorithm program that they enter in the awards data combined with living situation & it tells them just how much $ the applicant should have. You can't hide gifting or transferring, it will come up.

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