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My question is about someone who is past the "look back" period and has been on a combo of medicaid/medicare for years. They do receive SS and none of it is used to pay for their nursing home care, they have been in a nursing home over a year.
I am just wondering how monitoring of bank accounts is handled when someone is beyond the look back period and what types of transactions are "red flags". I have read they are allowed to have cash assets to a certain amount but also can't really freely spend that money?
This elderly person does not file taxes as they do not receive enough from SS to do so. She also tells me she has never had to go through a medicaid "recertification process".
I truly know nothing about it. I would appreciate any insight.

That 5 year lookback is only used when you first apply for Medicaid. In those 5 yrs you cannot transfer property, hide assets or gift large gifts. If this has happened, there are penalties and they will not receive Medicaid until the penalties are met. This means someone cares for you or pays for the NH.

If this person is on Medicaid and in LTC, their SS is being used for their care. The only time it may not be used, is if there is a surviving spouse who needs it to live on.

Are you a POA for this person? Someone has done a recertification. Its sent out every year by Medicaid. Maybe the office has done it. Maybe the person is a ward of the state. If so a state appointed guardian is handling everything for them.
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rachelann8987 Sep 6, 2025
A very new POA status to this person as their only living relative passed away. We haven’t even spoken to anyone at the NH yet. However, the SS is not being taken by the home it remains deposited into their bank account monthly- that is confirmed. They have been in the NH almost 2 years. This is why I’m so confused.
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I’m not an expert, but from what I’ve seen once someone is past the 5-year look-back, Medicaid usually just checks that they stay under the allowed asset/resource limit (often around $2,000, though it can vary by state). Spending isn’t totally restricted, but big withdrawals, gifting money, or unusual transactions can raise red flags. Day-to-day expenses like toiletries, clothing, haircuts, or even small comforts are generally fine.

Most states also require an annual Medicaid “recertification” (kind of like a renewal) where income and assets are reviewed again, though the process can be simple if everything is steady. If she’s never gone through it, maybe it’s being handled automatically by the facility or her state system
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Reply to TenderStrength5
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I’m no expert but I think you’re confusing the five year look back period, where records are checked for gifting of assets before a person can start receiving Medicaid, with allowable income while on Medicaid.
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I am assuming you are referring to medicaid community health for the "mediciad/medicare combo" you stated in the first sentence. This is different than Mediciad Long Term Care that is for Nursing Home residents. The look back 60 month period does apply when applying for Long Term Care. To my knowledge with only NY state it is not a seemless transition from community care insurance to Long Term Care because they two different programs. LTC involves a lengthy application, support documention and a 60 month (in most states) look back is still applicable even if previously on Medicaid community based care insurance.

When accepted into Mediciad Long Term Care all of the SS income will be payable to the nursing home (less the $50 personal allowance allocation that is a separate account managed by the facility).

Each state has their own asset threshold. Do not be confuse assets and income. Social Security is income that will be payable towards her nursing home (Long Term Care) monthly fee.
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rachelann8987 Sep 4, 2025
How long do they allow someone to stay in a nursing home before they convert them to Medicaid Long Term Care ?
Shes currently been in the nursing home close to 2 years.
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