I-2200, Look-Back Situations

Revision 09-4; Effective December 1, 2009

• When a person applies and is certified for Medicaid more than once because of multiple institutional stays or periods of ineligibility, the look-back date is based on the later of the earliest application for Medicaid or the initial entry into the facility.

Check automated systems, if possible, for the earliest application date on record.

• When an individual applies for a Home and Community-Based Services waiver program, the look-back period is based on the later of the date:
  • of application for the Home and Community-Based Services waiver program (completed, signed application form is received); or
  • after application that the person transfers assets.
• When a person applies for institutional care or a Home and Community-Based Services waiver program but is not certified and then reapplies, a new look-back period is based on the latest application.
• When a person applies and is certified for a Home and Community-Based Services waiver program, subsequently is denied, and reapplies for waiver services, the initial look-back period is still in effect.
• When a look-back period is established, the person is certified in an institutional setting, and then moves to a Home and Community-Based Services waiver program or vice versa, the initial look-back period is still in effect. This is true even when there is a gap in eligibility periods.
• Any additional transfers of assets that occur after the person is certified for Medicaid may be assessed a penalty.