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How does Medi-Cal’s look-back period of ineligibility work?

On Behalf of | Apr 27, 2023 | Medi-Cal and Long Term Care Planning

Medi-Cal, California’s Medicaid program, provides health insurance to low-income individuals, including seniors. who require long-term care. However, applicants must meet certain financial eligibility criteria for Medi-Cal’s benefits.

Sometimes, Medi-Cal applicants for a nursing facility level of care transfer assets for less than their actual value or make large gifts to loved ones in order to meet the asset limit and qualify for benefits. This is where the look-back period of ineligibility comes in – to scrutinize the asset transfers in the period leading up to an application for long-term care benefits.

You must disclose financial records for the look-back period

The look-back period of ineligibility for Medi-Cal is 30 months. Therefore, when you apply for Medi-Cal’s long-term care benefits, the agency will review your financial records for 30 months before the date of application.

If any transfers of assets are discovered during this period, you may be subject to a penalty period during which Medi-Cal will not pay for your long-term care. The length of the penalty period is calculated by dividing the amount of the transferred assets by the monthly cost of long-term care in your area.

For example, if you transferred $60,000 within the 30-month look-back period, and the monthly cost of long-term care in your area is $6,000, the penalty period would be ten months. Medi-Cal will only begin paying your nursing facility costs after the penalty period.

Proper planning is essential

To be fully prepared for any eventuality as a senior citizen, it helps to start making the necessary plans as soon as possible. You never know what the future holds.

Learning more about how long-term care planning works and how you can protect your interests and assets could save you a lot of trouble when the time comes.