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Understanding the look-back period for Medi-Cal

On Behalf of | Jan 18, 2024 | Medi-Cal and Long Term Care Planning

California’s Medicaid program, commonly referred to as Medi-Cal, provides essential healthcare coverage for low-income families and individuals. However, applicants must meet the eligibility criteria to qualify for this program.

The look-back period is a crucial component of Medi-Cal’s evaluation process, aimed at ensuring that only eligible individuals receive assistance. This refers to the timeframe during which financial transactions and asset transfers are examined to assess eligibility for Medi-Cal benefits. Its purpose is to prevent individuals applying for Medi-Cal from transferring assets just to meet the financial requirements.

The Medi-Cal look-back period is 30 months

If you choose to apply, you should know that your financial records for the five years before your date of application for Medi-Cal long-term care benefits will come under scrutiny to determine your eligibility. If you transfer assets to third parties during the look-back period to qualify, 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 depends on the amount of transferred assets and the average monthly cost of long-term care in your area. For instance, if you transferred $30,000 worth of assets within the look-back period and the monthly cost of long-term care is $5,000, the penalty period would be six months. Medi-Cal will only begin paying for your nursing facility costs after six months.

It is worth noting that certain asset transfers, like your primary residence, are exempt from this look-back period and may not affect your eligibility for Medi-Cal benefits. However, the legal landscape surrounding these asset transfers is constantly evolving, and it’s best to stay updated to avoid costly mistakes. Reaching out for legal guidance when applying for Medi-Cal benefits or planning your financial affairs can help you make informed decisions and protect your interests.