Spouse transfers exempt?

Yes \u2014 between spouses, no penalty.

Did 5-yr look back used to be 3?

Yes \u2014 DRA 2005 extended to 5 years.

Penalty starts when applied?

When otherwise eligible \u2014 assets spent down, in NH.

Spousal impoverishment protection?

Yes \u2014 community spouse keeps $30K-$148K assets + own income.

Yes \u2014 gift half, partial penalty + Medicaid for remainder.

Medicaid 5-Year Look-Back 2027

Medicaid look-back: 5 years pre-application. Gifts trigger penalty months: (gift amount / regional NH cost) = months disqualified.

Asset Transferred (gift) ($)

Regional Monthly NH Cost ($)

Months Since Transfer

Penalty

—

Penalty Ends

—

Look-Back Remaining

—

Transfer amount	—
Regional NH cost	—
Months since transfer	—
Penalty months	—
Penalty end	—
Look-back remaining	—

Medicaid's 5-year look-back rule (60 months) penalizes asset transfers made within 5 years of applying for nursing home Medicaid. Penalty = gift amount divided by regional monthly nursing home cost. This creates a period of ineligibility before Medicaid kicks in.

The Look-Back Window

States must review all transfers (gifts, asset divestitures) for 60 months before Medicaid application. Transfers >5 years old are exempt — encouraging early estate planning. Exception: transfers between spouses, irrevocable trusts for disabled child, certain caretaker child arrangements.

Penalty Calculation

Penalty months = gift amount ÷ regional monthly nursing home cost. Example: $100K gift / $9K regional NH cost = 11.1 months of Medicaid ineligibility. Penalty 'clock' starts when otherwise eligible (assets spent down, in NH). Doesn't tick during look-back wait.

Estate Planning Strategies

(1) Plan 5+ years ahead. (2) Use Medicaid Asset Protection Trust (irrevocable, 5-yr clock). (3) Spend down to exempt assets (house, car, personal items). (4) Annuity strategies. (5) Caretaker child rules. Always consult elder law attorney.

Last updated May 2026. Sources: Medicaid.gov Look-Back.