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Nearly everyone has heard that if you need assistance from the State for homecare or nursing home care, there is a five year look back period. Sometimes people think it is three years, which it used to be. And sometimes people ask if it is seven years, which must be the result of some rumor run wild, because it is not seven years.

On February 8, 2006 Congress passed and the President signed into law a five year look back provision for an applicant for Title 19 (Medicaid). The words “look back” mean just what they say. It is a period of time that the State of Connecticut Department of Social Services looks back through your financial records to see if you have made any unauthorized transfers in order to qualify for Medicaid. This does not mean you can’t have used some or all of your assets. It just means that you can’t have given money or other assets away with the purpose of reducing your assets so that you can qualify for the Medicaid.

Since this became fully effective in Connecticut in February 2011, it has become an administrative and accounting nightmare for applicants, their advisors, and the State of Connecticut Department of Social Services. The volume of records to review led to a tremendous backlog in applications for all those needing care, resulting in unacceptable delays for many months in approvals. That meant people were being denied care they needed to stay at home, and it is a goal of the Department of Social Services to keep people at home. It also led to a Federal lawsuit against Connecticut, alleging that the extreme delays were in violation of Federal law.

About a month ago that resulted in a revised and shortened procedure for reviewing records, in order to speed up the process.

The Department of Social Services will still be able to look at all records, but in the interest in saving time, will only look at two years of complete records, and will then look for 3 more years at six month intervals. They will then see if assets stayed about the same. If assets were about the same, the State will assume that unauthorized gifting did not take place.

In addition, the State will now only look at transactions of $5,000 or more, as compared to $1,000 or more in the past. That should speed things up quite a bit. This does not mean that people can give away funds as long as the gift is under $5,000. It simply means that unless there are red flags out there, indicating gifting, that the administrative process will be easier and quicker. This can be vital to someone who absolutely needs that extra care so they can stay at home, and not be forced into a nursing home.

It is still a difficult process, but there is a sigh of relief that deserving cases should be granted in a more timely fashion,

 

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