What is the five-year look-back?
When you apply for Medicaid coverage of nursing home care, the agency reviews your financial transactions for the preceding five years. Assets transferred for less than fair value during that window can trigger a penalty period — a span of time during which you are ineligible, calculated by reference to the value transferred.
The practical consequence: giving assets to your children shortly before needing care generally does not work, and can leave you worse off than doing nothing, because the penalty begins when you would otherwise have qualified — at the point you need care and have already given the money away.
Planning that works is planning done early. Five years early, as a rule of thumb.
What tools does planning use?
- Irrevocable trusts, which can remove assets from the countable estate if established outside the look-back window. See Irrevocable Trusts.
- Spousal protections, which allow a spouse remaining at home to retain a portion of income and assets.
- Exempt transfers, a narrow set of transfers not subject to penalty — for example to a spouse, or to a disabled child.
- Estate recovery planning. New York can seek recovery from the estate of a deceased Medicaid recipient, so planning considers what remains recoverable afterward.
None of these are do-it-yourself. Each carries trade-offs — an irrevocable trust means giving up control — and the wrong structure can be worse than no structure.
What this engagement looks like
You get an assessment of where you stand, what the realistic options are given your timeline, and a written summary of recommended next steps — including, where an application is needed, a referral to counsel who prepares them.
If you are already in a crisis — a parent in hospital facing a discharge to a nursing home — say so when you call. Crisis planning is a different exercise from advance planning, with fewer options, and it is time-sensitive.
Frequently asked questions
What is the Medicaid look-back period in New York?
Five years for nursing home Medicaid. Transfers made for less than fair value during that period can create a penalty period of ineligibility. Rules for community-based home care Medicaid differ and have been subject to change — ask about current status.
Can I give my house to my children to qualify for Medicaid?
Generally not without consequence. A transfer within the look-back can create a penalty period. There are narrow exempt transfers, and there are structures that work if established early enough, but an outright gift shortly before needing care usually causes harm.
Does this firm handle Medicaid applications?
No. The firm provides advice and planning strategy and will refer you to counsel who prepares and files applications.
When should Medicaid planning start?
Ideally at least five years before care is needed, because of the look-back. Planning is still possible closer to the need, with fewer options available.
Will Medicaid take my house?
Not during your lifetime while it remains exempt, but New York can pursue estate recovery afterward. Planning addresses what remains recoverable.
Related: Estate Planning Advisory · Wills · Powers of Attorney · back to Estate Planning
Written by Dale Riedel, Esq. · Admitted in New York, Bar No. 5837539