I heard that the lookback time for Medicaid has changed to be 6 years instead of 5 yrs. Is this true? What have you heard? Concerned about Medicaid for the nursing home payment assistance.

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Yes, a state can do a 7 yr. But most don’t as it’s too unwieldy to do.

My understanding is federal administrative code done in the 1990’s allows a 10 yr lookback and Estate Recovery. What states did - as each state manages its Medicaid program uniquely but within overall federal guidelines - was all over the place..... so some states did 6 mos, others 3 yrs, others 5 years. Some states allowed those just needing custodial care to go into skilled nursing facility. Some states did no recovery at all, while others did only for those with homes over 500k. Meanwhile Medicaid LTC and Medicare $ paid services in a SNF were hugely rising and all this tracked in real time and by ICD codes by CMS. CMS - Center for MediCARE and Medicaid & CMS reports regularly to Congress.

So to deal with this, In 2005, Bush did DRA - Deficit Reduction Act, which required all states to all have a minimum uniform standard for LTC Medicaid programs for eligibility (both financial AND medical) and estate recovery to get things even & hopefully more cost efficient. The 5 yr lookback and MERP had to be done in some way to meet the federal standards by all states to get their federal share of dedicated federal medicaid LTC (skilled nursing care) funding.

The 5 yr was the feds standard but state can do more if a state has staff & software to do a longer financial review.

Please PLEASE remember that they have to also be “at need” medically for skilled nursing care. States seem to be really tightening up on that review. And most states Medicaid do NOT have AL waiver programs or if they do the waiver has years long waiting list for an open bed. Just being elderly & iffy on their ADLs and needing medication management may not be enough to be “at need” medically for a NH nowasdays.

Folks tend to get all about the $$$ when thinking of Medicaid but being medically “at need” is just as important to be eligible as well.
Helpful Answer (3)
Reply to igloo572

I haven't heard that the change has been made. Someone mentioned they want to go back as much as 7 yrs.
Helpful Answer (0)
Reply to JoAnn29

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