What Is the Florida Medicaid Look Back Period?

Under 42 U.S.C. 1396p(c)(1)(B), for an institutionalized individual, the look back date is 60 months before the first date on which the individual both is an institutionalized individual and has applied for medical assistance. The DCF manual states that the look back period for transfers other than trusts is 60 months and counts back from the month of application. The DCF manual also considers transfers made at any time after applying.

A transfer for less than fair market value during that period can cause a penalty. During the penalty, Medicaid does not pay for nursing facility care or home and community based waiver services. The number of months generally equals the uncompensated value divided by the average monthly cost of private nursing facility care, and the federal statute does not allow that figure to be rounded down.

The DCF manual presumes that a transfer was made to obtain Medicaid eligibility. A penalty period is imposed unless the individual presents convincing evidence of one of the grounds listed in passage 1640.0606, such as a transfer made solely for reasons other than to become eligible for Medicaid.

Section 1396p(c)(2) lists exceptions. They include transfers to a spouse, transfers to a disabled or blind child, transfers to certain trusts for a disabled person under 65, and transfers of a home to certain relatives, such as a son or daughter who resided in the home for at least 2 years immediately before the individual became institutionalized and who provided care that permitted the individual to reside at home rather than in an institution. They also cover cases where the person shows the transfer was made for another purpose, the assets were returned, or denial would cause undue hardship.

Planning ahead of time is discussed in asset protection.