Nancy E Kline

When a person applies for Medicaid, he can request coverage for the current month and for the three prior months, assuming that he was eligible during those prior months. 18 NYCRR 360-2.4 (c). If he does this, what is the beginning of the look-back period for transfer of assets? For example, if he applies on July 1, 2015 and asks for coverage beginning April 1, 2015, does the look-back period go back to July 1, 2010 or April 1, 2010?

GIS 15 MA/07 addresses this issue.

The GIS says that the look-back period is the 60 months immediately prior to the date that an individual is both institutionalized and has applied for Medicaid (the application date). The GIS specifically uses the word “both.”

The GIS says that if an applicant is requesting coverage of nursing home care for the three-month retroactive eligibility period: the look-back period is 60 months immediately preceding the month of application. In the past, Departments of Social Services had looked back to the 60 months prior to the first month that Medicaid coverage was sought, including the three retroactive months. Effective immediately, Departments of Social Services are limited to the 60 months immediately preceding the month of institutionalization and application.

Thus, in the above example, the look-back period would go back to July 1, 2010. It would not go back to April 1, 2010.

The GIS also says that if a Medicaid recipient requests an increase in coverage, the request can be for coverage of up to three months prior to the date the request is received by the Department of Social Services. In that case, the look-back period would be 60 months from the date of institutionalization, not 60 months from the date the increase in coverage is made.