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Is it done by counting back to the exact date that makes 5 years. For example 2/1/11 to 2/1/16 or they go to the nearest month etc.

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They do look at the records for assets that date back to whatever the look-back period is for the state. Medicaid is not an all-or-none thing. An asset that was transferred 4 years prior to application would have a smaller penalty than one transferred a week before applying. There is a formula they use in determining penalty that includes the value and the time. The main point of look-back is keeping people from gifting their assets with the goal of applying for Medicaid in mind.
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