Understanding the Medicaid 5 Year Look-Back Period

HNWApplying for Medicaid Long Term Care Benefits

  • NJ medicaid lookbackAn applicant’s Medicaid application was denied because of bank deposits made 58 months prior to filing.

I recently read a post where a Medicaid application was denied because of bank deposits made 58 months prior to the qualification date.  The client does not have any documentation or memory regarding the deposits (he’s been in a nursing home for five years), and the bank into which the deposits were made does not have copies of anything.  Apparently, the bank lost or never had copies of the deposit slips and/or checks deposited.  Had the attorney known about the problem obtaining documentation, he/she would have waited beyond the 5 year look-back before filing the initial application.

Thereafter, a new application was submitted for qualification 60+ months after the problematic deposits.  The County Board of Social Services is again requesting information on those deposits, even though they were made outside the look-back period because a prior application had requested that information within the five (5) year look back period.

The Board of Social Services is saying that unless documentation regarding those deposits is submitted (which are simply not available from the client or the bank), the application will be denied and this applicant will never qualify for Medicaid.

Unfortunately, this resident is screwed.

I’ve written a series of posts that discuss federal law HCFA on the timing of filing Medicaid applications.  The state’s position is once you file, regardless of the outcome or number of times you file subsequent applications, all applications relate back to the first application.  It says to me that while you can withdraw a filed application, you’re screwed thereafter as any future application will relate back to the date of the first filing.  The term “having applied” means actually having the application posted as received by the County Board of Social Services.

The best advice I can/could offer was to claim the deposits were gifts and hope the county will impose a penalty limited to the unexplainable deposits.

If you are looking for additional details on this topic or if you require advice about your situation, please contact Fredrick P. Niemann, Esq. toll-free at (855) 376-5291 or email him at fniemann@hnlawfirm.com.  Please ask us about our video conferencing or telephone consultations if you are unable to come to our office.

By Fredrick P. Niemann, Esq. of Hanlon Niemann & Wright, a Freehold Township, Monmouth County, NJ Medicaid Application Attorney

Previous PostNext Post