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Who's Afraid of the Medicaid Lookback Period?

Posted by Chad Seiter | Dec 13, 2021 | 0 Comments

What is the Medicaid “Lookback Period” in Kentucky?

As seniors age, they may require more assistance with basic needs. For seniors who qualify, for long-term nursing home care. However, the process of obtaining a Medicaid waiver can be lengthy and complicated. Many elders and their families mistakenly try to rid themselves of assets in order to qualify based on income guidelines, unaware of the lookback period. What should Northern Kentucky seniors and families know about the Medicaid application process?

What is the Lookback Period for Medicaid Eligibility?

Medicaid is distributed through a combination of federal and state resources. Medicaid is administered by both the Centers for Medicare and Medicaid Services (on the federal level) and the Cabinet for Health and Family Services (on the Kentucky state level). Medicaid is sometimes used to pay for long-term care health resources if an elder qualifies based on limited financial means. However, it is important to keep in mind that the lookback period for Medicaid eligibility in Kentucky is five years, or 60 months. This means that CMS and the state agency providing benefits will look at an applicant's income and assets from the last five years to determine if their net worth exceeds eligibility guidelines.

Avoid Potential Penalties and Using Penalties to Your Advantage

If you believe you may require Medicaid nursing home benefits in the future, you may want to meet with an elder law attorney on how best to manage your assets, protect your home, or place property in a Medicaid trust five years prior to applying for assistance. If you attempt to rid yourself of assets in order to lower your asset qualifications within the lookback period, and subsequently receive benefits, you may be subject to penalties, or your eligibility for Medicaid assistance could substantially be delayed.

For example, say that two years ago an elderly father sold his home and divided the proceeds between his two children. He then moved in with his eldest daughter. If after that two-year period, he would not be able to obtain Medicaid long-term care benefits if the sale proceeds were handled unproperly, and he would be forced to pay out of pocket despite his current financial predicament. With the help of an elder law attorney, the elderly father could be counseled on how to avoid such a situation.

That said, it is possible in certain circumstances, to you use a penalty period to your advantage. This strategy is often employed during crisis planning cases--those cases when someone is admitted into a nursing home with considerable amount of assets. 

What About Medicare Benefits?

Many people assume that Medicare, which provides for senior health care expenses regardless of income, would also cover the cost of long-term health care in Kentucky, but it does not. Part of the reason is because long-term care and nursing care consists of more than just health services. For this reason, families need to discuss long-term care needs long before they may actually require services to avoid emergency crisis care planning.

Contact Northern Kentucky Long-Term Care Planning Lawyers at Darpel Elder Law

Long-term care planning is a daunting process, during which missteps can easily be made. Many parties do not know when they should start thinking about it, let alone putting that plan into action. Often families may be left in crisis mode when their loved one experiences a serious medical issue requiring around the clock care. Our attorneys at Darpel Elder Law Group provide long-term care planning and crisis planning assistance for all families throughout Northern Kentucky. Call us today to schedule a thorough consultation and review next steps.

About the Author

Chad Seiter

Attorney at Law

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