Many people believe that they don’t need an attorney to complete a Medicaid long-term care (LTC) application. Many people try to do it for their loved ones or allow the hospital or nursing home to do it for them. The problem is that most people don’t understand the rules surrounding Medicaid qualification, penalty periods, and estate recovery. If the person doing the Medicaid LTC application doesn’t understand these rules, the application is likely to be denied. But, if the application is approved, consideration is not usually given to estate recovery.

What is the 60-month look-back?

When a person submits a Medicaid LTC application, the Department of Social and Health Services (DSHS) assigns a case worker to verify the amount of assets that the applicant currently owns. If the applicant is within the allowable asset limits, the DSHS case worker then examines every transaction that has taken place in the 60 months prior to application submission. DSHS will request 60 months of financial statements from every account the applicant owned in the last 60 months. If an asset has been given away or sold for less than fair market value (FMV), DSHS calls this an uncompensated transfer. DSHS presumes that every uncompensated transfer was made for the purpose of qualifying for Medicaid. DSHS adds all uncompensated transfers in the last 60 months and applies a penalty period based on the total amount they consider to be uncompensated.

What is a penalty period?

The penalty period is the amount of time that an applicant, who meets the eligibility criteria, cannot receive benefits because of any uncompensated transfers they made during the 60-month look-back period. Even though the look-back period is limited to 60 months, the penalty period is not.

Even if an applicant’s countable assets are within the allowable limits and no penalty period is applied, exempt assets are still subject to estate recovery after the Medicaid recipient’s death.

What is estate recovery?

Estate recovery is when DSHS recovers the amount that was paid on behalf of the Medicaid recipient after their death. The home, vehicle, and personal property that you may have been told was exempt assets are only exempt for the purposes of qualification. When the Medicaid recipient dies, Medicaid has the right to recover the amount they paid, out of the Medicaid recipient’s estate.

What can Orca Law Group do to help?

Orca Law Group can help you figure out the best path forward whether it is in Medicaid pre-planning or a Medicaid Crisis situation. We can help protect assets and accelerate Medicaid LTC qualification. Contact us today for a free Medicaid Qualification Analysis.