I need to better understand the legal aspect of the 5 year medicaid look back .

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Can anyone answer this question. My mom has been in a home since late 2006 and is under medicaid. At the time, I was unaware that I had to disclose that she had a life insurance policy and years later, I realized I had to after maintaining the premiums for her. I did notify the caseworker in year 2010 when is time for re-certification under medicaid. I gave all info incl the transfer of ownership in my name and assigning to funeral home. the cash surrender value from 2006 was within the resource eligibility even if that info was not disclosed until a few years later. I did not get any questions from the caseworker. My question is.. how does this play in the 5 year look back period and will i get any repercussion but again, all is now corrected with medicaid. Is the medicaid 5 year look back period each time a medicaid application is submitted. Can someone answer me?
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For Medicaid, the regulations and administration are state specific even though it is a federal program. Most states have the max monthly total asset of 2K. Over that you need to start to “spend down” the money. “Spend down” – means get assets (excluding homestead & car) under the state’s Medicaid asset ceiling. They can buy funeral and burial policy, life insurance (irrevocable NCV). Glasses, dental care (spotty on Medicaid), hearing aids, walkers. If they have a home, prepay for utilities, cable, insurance, repairs. No $ gifted to others. Everything must be for their care or their property. Medicaid look back is 5 years. The state can go thru 5 years of bank records & also require receipts to any item that pique’s their interest.
By applying for Medicaid, you sign off on an all-access pass without getting the cool lanyard to wear & show you were with the band....rotflmao. I found that having an attorney evaluate the situation was a great spend-down item.

For my mom (Texas), I had to go to her bank and sit with a bank officer to have them do a letter as to the disposition of each and every account, CD, T bill etc as to when they were closed, cashed out or where transferred to for a full 3 years back from the 6 months of current bank statements provided with her application. So her look-back was 42 months. Fortunantly years ago, I had her move everything to a single bank and got her down to a single checking account which her investment accounts paid all dividends into. So there was a pretty clear pattern for her income for years and years. Now when something expired it went into this main drawing account. So the bank letter was something like...CD # 1234 amount $ 5,456.00 deposited in checking account # 6789. The letter was 2 pages and notarized. Took over 4 hours for them to do and the bank officer was great and there was no charge for doing this. I would imagine not all bank are friendly about doing this.

It's my belief that the caseworkers are looking for a pattern of spending for red flagging an application and sending it for a higher level of review. My mom paid for IL for a couple of years before she went into the NH, so her bank statements clearly showed a pattern of where her $$$ was spent. If she had been at home, her application probably would have been more scrutinized. We too had a problem with her $1,000 face value term life insurance. It was old from the 60’s when policies were 20 – 30 pages, so you had to read through it for the word term. The Medicaid worker doesn’t have time for THAT level of detail and doesn't hold an insurance license to be qualified to evaluate how a policy reads and therefore can't couldn’t check whole or term but could check information not provided. So I get a letter requesting clarification on the insurance policy info asap (72 hours). I got a stockbroker, who holds TX insurance license, to do a letter that the policy was term and faxed it to HHS. Had a couple of other issues like the legibility of my mom's naturalization papers was iffy so I also included her old passport. I did this on my own, it was not requested, and the caseworker said that it was a good thing as otherwise I would have had to have requested a copy of her naturalization paperwork from the US State Dept. I think submitting the application with all the required information in one giant document makes a big difference in it getting processed as you want to do whatever to cut down the time the state caseworker can think about the documents or has to wait to get a document and then perhaps re-review the documents and find something to question.

I know it can seem daunting. Sometimes overwhelming. My mom's Medicaid application with the supporting documentation was over 100 pages - mainly because of all the pages (front & back) of her funeral, burial & term life policy. I am pretty OCD when it comes to paperwork, and we still had glitches in her application both from the NH side and the state Medicaid review that required sending documents more than once…….Whatever you do make copies of all you submit; never submit anything original. If your parent's have their records together, you can probably do an asset evaluation in a long weekend to see where they stand and how much $ needs to be correctly spent down and then see an elder care attorney. If you are facing a short time frame (like imminent NH admission) then alot of this you will just have to take time off to walk it all through. Good luck, find a FedEx/Kinko's office that's close-by & keep a sense of humor (you’ll need it).
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I just went through this so I can give you some information.

The 5-year look back period covers all financial transactions that a Medicaid applicant has undertaken.

You have to disclose all income, retirement statements, tax returns, etc...for the 5 years.

So there are several things you need to do when complying with the 5 year rule...

1) Provide all of the information to Medicaid. As a caregiver you will need a power of attorney to access bank records and retirement statements.

2) When you receive the 5 years of bank statements (you shouldn't have to pay for them...Chase waived the $6 per month fee for me due to the fact that I was attempting to get the bank records because of a Medicaid application) you will have to account for every single deposit over those 5 years.

This means that anything that was deposited that wasn't part of your loved ones regular income or a pension will have to be explained.

It is not as bad as it sounds. What you will do is sit down with the social worker and they will go through the 5 years of statement and let you know which ones Medicaid will question.

You then need to go back to the bank and request the deposit slips for those transactions.

When I did this for my mother these deposit statements came back as just cash she was putting into the bank. So long as I had the deposit slips it was ok.

Now the REALLY frustrating thing was what happened after Medicaid requested clarification of certain things with her application. And I can understand the government wanting to make sure Mom wasn't rich and hiding the money with me.

But what this bureaucrat did was give me 48 hours to come up with a laundry list of information or I would have to start the application over. And the worst part was that most of it had already been submitted...they just couldn't figure it out.

As an example, Mom had a small term life insurance policy. Well, a term life policy doesn't have a cash value. I submitted the declarations page of the policy to show that. BUT THAT IDIOT STILL WANTED A LETTER FROM THE INSURANCE COMPANY SAYING THERE WASN'T ANY CASH VALUE.

I did manage to get the situation rectified but the best advice I could give you is...

1) Move as quickly as possible to get the information
2) Be prepared for the disruptions in your life. Sit down with your boss and explain the situation so if you need to take a "sick" day dealing with social workers and government bureaucrats they understand up front.

I hope this helps and if I could give you any advice on how best to go about the process feel free to let me know.
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When you apply for Medicaid you must disclose any money or assets you have given away or sold significantly under the fair market value in the last five years. There will be a penalty (in delayed eligibility for Medicaid) if there are significant gifts during that period.
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I don't know much, but I think you should talk to a lawyer to find out the legal issues. They would know best. I found a free lawyer at my senior center.
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