Back-Up and Look Back – Medicaid Look Back Periods – At the Conference Table 2


Greg: Look back periods, we’re on look back periods. What is that?

It’s Friday, September 23rd, and the longest toughest week ever. I was in court until 9.00pm last night, night court dealing with guardianship issues which I can’t talk about.

People may come in here any minute so we better tell everyone about look back periods.

Did you want to say anything for Hayden’s Happy Place?

Hayden: Well I did intend to do it today. So, I love the way Greg signs his emails. And I was thinking, we had a client, a young man, he had a traffic case for you, which was unusual. Nevertheless, he said, have a nice day, so, I was telling him, you know, Greg signs all of his emails, or letters, or whatever, ‘Make it a great day,’ and I thought a lot about that, and I told him, that’s a choice we have, we don’t just have one, it doesn’t just fall out of the sky and happen to us.

Greg: You could have a crappy day, a horrible day, you choose to react to what happens to you. So react in a positive way, no matter what happens. What harm can it do.

Hayden: We can’t always control what happens to us, but we do control how we react to it, and how we think about it, and deal with it. But I was thinking, we have 52 weeks a year, and of those 52 weeks, how many do we actually remember?

We get up, we go do something outside in the yard, or do laundry, or go shopping, nothing memorable. How many weeks do you remember Greg? You probably can because there has been several that were memorable lately.

There was Chicago. That was fun. And one of the things you enjoy is working with elder counsel, and you were presenting in Chicago.

Greg: I had the privilege of presenting to a nation-wide group of elder law attorneys recently in Chicago, Illinois, and passing out my book to them. Giving it away as door prizes, and it was awesome. Anything I can do to help and learn. I learned a ton. So you think I have memorable days, and people should remember their days?

Hayden: On a day to day basis, most people could probably not remember more than 5 weekends. I think that ought to be a goal sometimes. To do something you will remember. So I’m thinking, let’s make this a great week. Look at what we have to do, and then in our free time we should plan something we will remember.
My grandchildren love to go up to Lake Lure and climb over the rocks and jump in the river. Just jump from rock to rock. You have to portage some of the way because it gets too rocky.

Greg: I don’t even know what that means, portage.

Hayden: Portage is when you carry your canoe on land around un-navigable areas.

Greg: Sounds French.

Hayden: It probably is, but Americans do it to. So that’s my happy place, making it a great week.

Greg: Let’s make it a great week. I firmly believe that you are in control of your own destiny. I take responsibility for things that happen to me, and around me, whether they’re directly related or not.

Unless you do take responsibility for those things, from making it a great day, to controlling your attitude, or controlling time, you put yourself at the mercy of that thing, and everything that goes on around you. So that’s why I say, ‘Make it a great day,’ because it’s your responsibility, it’s your choice.

So, let’s talk about look back periods.

What is a look back period? Why would you apply for Medicaid? Let’s start there. Why would a senior ever apply for Medicaid?

I talk about this in my book, ‘Saving The Farm,’ I mean we really get into it. I had clients today, who have read the book, and knew, they knew what they wanted to do. This is what I want. It’s nice, it’s being knowledgeable. But back to the look back period. So many seniors burn through their money, like flipping through this book, like water, because it costs somewhere between $60,000 – $100,000 per year for nursing home care, assisted living care, dental care, but Medicaid is not necessarily going to pay for dental care okay. So, what happens if you burn through all your money, what happens to your house, to your property?

Hayden: Medicaid puts a lien on your house, it passes through probate, they change the title, and it gets sold to the highest bidder usually.

Greg: So what happens if all the money’s been spent, and the wife is afraid because she has another 20 or 30 years to live, and her husband is in a nursing home, burning through the money? How do we put a stop to that?

Hayden: A ladybird deed can.

Greg: A Ladybird deed can work. Put a Ladybird deed on a house and it beats the look back period. There are two types of Medicaid for nursing home and assisted living care. They’re different types. ‘Special Assistance Medicaid’ is for assisted living. ‘Nursing Home Medicaid’ is Long Term Care Medicaid.

Special Assistance Medicaid for assisted living has a look back period of 3 years.

Hayden: And by look back period, you mean all the money you spend and the way you pay off your assets during the previous 3 to 5 years (however long the look back period is for).

Greg: Nursing Home Medicaid has a look back period of 5 years.

Hayden: So there are certain ways you can spend money that are acceptable, and other methods that are not, such as giving away massive amounts, or considerable amounts of money to your family.

Greg: If it’s not a regular pattern of gifting, and you give money to a family member, within that time, it will count as a penalty. The Medicaid system are going to penalize you for a certain period of time, until they will actually come in and pay for healthcare.

So, if we’re doing a benefits case, we’re going to comb through 5 years of bank statements for Nursing Home Medicaid, and 3 years for Special Assistance Medicaid. We will go through them all and look at spending.

Hayden: An attorney markets ways that no one outside of being an attorney would know. It’s things that you and the elder counsel have come up with and developed, or discovered loopholes or whatever.

Greg: They’re not loopholes, it’s just, the rules are complicated. So, we say, here’s what we did, here’s how we did it, or sometimes we’ll take a penalty period. But to get back to the look back period, Nursing Home Medicaid has a 5 year look back period. Traditionally, without real creative thought and knowing all the rules, you have to do a spend down. Also all your moves (transfers of property to kids) to protect property, would have to be outside the 5 years look back.

Hayden: Now, the IRS says you can give $14,000 dollars.

Greg: I’ve had that question before, ‘hey can I give every member of my family $14,000 dollars and it’s not reportable?’ Yes and No.

Yes, you can give up to $14,000 dollars and not report it to the IRS, because it’s a gift, it’s not reportable. But anything over that, you have to report. And how that works is, it just counts off how much you can give during your life, or in death, tax free. So that has nothing to do with look back periods.

If you start giving away $14,000 during your look back period, you are going to rack up huge penalties before Medicaid will come in and apply time relative to that dollar amount.

There’s a formula built in to the statutes, that allow you to calculate that dollar amount. We get ahead of the game. We do all these calculations, but we also do the legal work. Social workers are the experts for putting in the acts?? (16:27) and the rules, the problem comes about because their hands are tied. They cannot give you legal advice.

So look back periods are the time before you applied, that you have to get everything done in. And if you’re within that time period, what if you didn’t plan ahead? Come see me. I can save the money, and I can save the real property with the different tools and the strategies I have. So what would you sum up. What are look back periods?

Hayden: It’s a 5 or 3 year period, depending on the type of care you need, in which Medicaid is going to look at your expenditures, and if they feel you have tried to hide money or spend money, you’ll be penalized.

Greg: They are simply a set of rules about how you can spend money during that look back period. If you don’t follow those rules, then you’re penalized for that amount of money, and you have to pay it back, or, you have to wait the time commensurate with that amount of money. Say, if it was $60,000, they might penalize you for a year.

So that’s how it works.

But, we can help you fix it, or we can help you with the spend down, emergency Medicaid planning is a department we have.

So what’s coming up this week?

Hayden: Healthcare fairs around Shelby and Cleveland County, we are going to have booths there. Next Friday, I will have the whole list for you. Or you can go to the McIntyre elder law facebook page, we have a list of all those activities.

Greg: Next week we are going to talk about Medicaid Asset Protection Trusts. So, we’re going to play some monopoly and go through some pre-planning okay.

This is ‘At the Conference Table’ with Hayden and Greg, see you next week, Friday at noon.

To get a copy of ‘Saving the Farm,’ you can get it at or you get it through my office McIntyre Elder Law. The audio book is out, you can get it on Audible, or iTunes. Or you can get the enhanced e-book, which has all the video and audio interviews right in the book.

Call me if you have any questions:

Greg McIntyreGreg_Full
Elder Law Attorney
McIntyre Elder Law
123 W. Marion Street, Shelby


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Greg McIntyre, founder of McIntyre Elder Law, is more than just an attorney. As a Navy Veteran, father to six kids, and a loving husband, he values family deeply. This drives his commitment to helping clients safeguard their futures and pass down legacies.

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