Many people help out their family members and don’t realize that it could cause an issue if they try to apply for Medicaid. Medicaid law imposes a penalty period if you transferred assets within five years of applying; but what if the transfers had nothing to do with Medicaid? It is difficult to do, but if you can prove you made the transfers for a purpose other than to qualify for Medicaid, you can avoid a penalty.
You are not supposed to move into a nursing home on Monday, give all your money away on Tuesday, and qualify for Medicaid on Wednesday. So the government looks back five years for any asset transfers, and levies a penalty on people who transferred assets without receiving fair value in return. This penalty is a period of time during which the person transferring the assets will be ineligible for Medicaid. The penalty period is determined by dividing the amount transferred by what Medicaid determines to be the average private pay cost of a nursing home in Pennsylvania (which in 2018 is about $330 a day, and which changes every year).
The penalty period can seem very unfair to someone who made gifts without thinking about the potential for needing Medicaid. For example, what if you made a gift to your daughter to help her through a hard time? If you unexpectedly fall ill and need Medicaid to pay for long-term care, the state will likely impose a penalty period based on the transfer to your daughter.
To avoid a penalty period, you will need to prove that you made the transfer for a reason other than qualifying for Medicaid. The burden of proof is on you, the Medicaid applicant, and it can be difficult to prove. The following evidence can be used to prove the transfer was not for Medicaid planning purposes:
- The Medicaid applicant was in good health at the time of the transfer. It is important to show that the applicant did not anticipate needing long-term care at the time of the gift.
- The applicant has a pattern of giving. For example, the applicant has a history of helping his or her children when they are in need or giving annual gifts to family or charity.
- The applicant had plenty of other assets at the time of the gift. An applicant giving away all of his or her money would be evidence that the applicant was anticipating the need for Medicaid.
- The transfer was made for estate planning purposes or on the advice of an accountant.
Proving that a transfer was made for a purpose other than to qualify for Medicaid is difficult, and the Medicaid system in Pennsylvania generally resolves any doubt in favor of the state. If you innocently made transfers in the past and are now applying for Medicaid, consult with us by clicking here and filling out our simple form and we'll be in touch.