When it becomes time for a parent or loved-one to go to a long-term care facility or nursing home, the most common way to pay for that care usually is Medicaid. Medicaid for long-term care is receiving financial assistance from the federal government (administered by the State of New Hampshire Department of Health and Human Services). There are many different pieces to the application, but two of the most important to understand are the Look-Back Period and the Disqualification Period.
The Medicaid Look-Back Period, in New Hampshire for 2022, is the immediate five (5) years leading up to the date the application for Medicaid is filed. If someone files a Medicaid application on December 1, 2022, the Look-Back Period will be December 1, 2017 through December 1, 2022. The Department of Health and Human Services will assign a Social Worker who will request all of the financial records of the person applying (the person in the nursing home or “Medicaid Applicant”) for this period of time. This will include all bank statements, all financial account statements, any interests the Medicaid Applicant may have in any trusts, records of any and all assets of the person in the nursing home, and the Social Worker will ask if there were any transfers of any assets out of the name of the Medicaid Applicant in this time period and request copies of those documents.
The Social Worker will then look through all of these documents to determine whether or not the person qualifies for the program applied for, and looking for any “Disqualifying Transfers”. After the Social Worker has reviewed all of the financial transactions of the Medicaid Applicant, a meeting is held where the Social Worker will ask about any transactions or transfers that may have been gifts to family or friends during that five (5) year period, and will ask about any transfers of assets out of the Medicaid Applicant’s name. After the meeting, or at the meeting, the Social Worker will add up all of the transfers that they determined were “Disqualifying Gifts”. These are gifts to friends and family that could be seen as an attempt to hide or transfer money for purposes of qualifying for Medicaid.
Once the total dollar figure of disqualifying transfers is determined, the Disqualification Period is calculated. The Social Worker will divide the amount of total disqualifying transfers by the Medicaid payment rate for the nursing home that the Medicaid Applicant lives at. That number will be the number of months that the Applicant is disqualified from receiving Medicaid to pay for the nursing home. For example, if the Applicant gave $10,000 to their child within the Look-Back Period, and the Medicaid rate to pay the nursing home is $5,000 per month, the Applicant will be disqualified from receiving Medicaid to pay their nursing home for 2 months. During that time, the family will need to find another method for paying for the nursing home care.
The Disqualification Period does not begin to run until the later of the Medicaid Applicant entering a nursing home, or the Applicant qualifying for Medicaid. This means that the Applicant must be BOTH qualified to receive Medicaid to pay for nursing home care and have applied for Medicaid before the Disqualification Period will begin to run. This means that the timing of filing the Medicaid Application can be incredibly important because it will determine whether or not a transaction will be reviewed and could disqualify a Medicaid Applicant from receiving Medicaid. It is important to seek the advice of an attorney BEFORE applying for Medicaid to ensure that the timing of the application will not trigger a Disqualification Period.
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