How the New York Medicaid Look-Back Period Works for Nursing Home Care

When a family begins the process of applying for Medicaid to cover a parent's or spouse's nursing home care, one of the first requirements they encounter is the look-back period. I explain it to families early, because it affects the financial decisions made in the years before the application. The rules are technical, but the framework is straightforward once it is laid out in plain terms.

The 60-month review

For nursing home Medicaid in New York, the look-back period is 60 months, or five years. The review runs backward from the month in which the applicant is both in a nursing home and has applied for Medicaid. During that window, Medicaid examines whether the applicant or the applicant's spouse transferred money or property for less than its fair market value. In New York City, these applications are handled by the Human Resources Administration (HRA), and the applicant must document accounts, property, and trusts going back the full 60 months. The Supplement A form that HRA uses for nursing home applications asks applicants to list accounts closed during that period, explain where the closing balances went, and provide a written explanation for each transaction of $2,000 or more. That is why I advise families to begin gathering five years of statements as early as possible, rather than waiting until after a hospital discharge.

What counts as a transfer

A transfer is any gift, or any sale for less than fair market value. The most common examples I see are cash gifts to children or grandchildren, adding a child's name to a deed, selling a home to a relative at a reduced price, and moving assets into certain trusts. Ordinary spending on the applicant's own needs is not a transfer. Paying for the applicant's own groceries, repairs, or medical bills is not a problem, provided there are records. Transfers made more than 60 months before the application are not reviewed at all. As we discussed in a prior article on trusts, an irrevocable trust funded more than five years before a nursing home application can protect assets without triggering a penalty.

How the penalty period is calculated

If Medicaid finds an uncompensated transfer within the look-back window, it does not deny the application outright. Instead, it imposes a penalty period during which Medicaid will not pay for nursing home care. The length of the penalty is calculated by dividing the total value of the transfer by a regional rate set by the New York State Department of Health, reflecting the average monthly private-pay nursing home cost there. For applications filed in 2026, the rate for New York City is $15,282 per month, so a $76,410 gift would result in a five-month penalty. The penalty does not begin on the date of the gift. It begins only once the applicant is in a nursing home, has applied for Medicaid, and would otherwise be eligible, meaning assets have already been reduced to the allowable limit. That is why I advise families not to make gifts shortly before a nursing home stay without first reviewing the timing, since the family may be left responsible for the cost of care during the penalty months.

Transfers that are exempt

Not every transfer triggers a penalty. New York law exempts several categories, including:

•         Transfers of any amount between spouses.
•         Transfers to a child who is blind or permanently disabled, or to a trust for that child's sole benefit.
•         Transfers to a trust for the sole benefit of a disabled individual under age 65.
•         Transfer of the home to a child under 21, to a sibling who has an equity interest in the home and lived there for at least one year before the applicant entered the nursing home, or to a child who lived in the home for at least two years and provided care that allowed the parent to remain at home.

I recommend reviewing any exemption with an attorney before relying on it, because the supporting proof matters as much as the rule itself.

Home care is treated differently

The 60-month look-back applies to nursing home Medicaid. New York enacted a 30-month look-back for community-based long-term care, such as home attendant services and managed long-term care, but as of this writing it has not been put into effect, and transfers are not currently penalized for home care applicants. Keep in mind that a person receiving home care today may need nursing home care later, and the full 60-month review will then apply.

Preparing for the application

The most effective way to handle the look-back is to address it before it becomes urgent. I work with families to gather five years of financial records, identify any transfers that may raise questions, confirm which ones fall within an exemption, and time the application so that any unavoidable penalty period is as short as possible. When a family understands the rules and has its documents in order, the application process becomes far more manageable, and care can begin without unnecessary delay.

If your loved one needs nursing home care and has made gifts or transfers which need to be reviewed before applying for Medicaid, contact us today at (347) 766-2685 for a free phone consultation.

Contributed by Roman Aminov, Esq, a Queens estate attorney in New York City.