Standard Tier Module
Medicaid 5-Year Look-Back Penalty Calculator
One deterministic, in-browser tool for senior-care, aging-services, and elder-law work.
Run it on your own figures, 100% in this browser tab
What it is
One deterministic, in-browser tool for senior-care, aging-services, and elder-law work. Computes the Medicaid transfer-of-asset PENALTY PERIOD under the 60-month (5-year) look-back (42 U.S.C. 1396p(c)): penalty months = total uncompensated transfers / the state penalty divisor (the state average monthly private-pay nursing-home cost), kept as an exact fraction OR floored to whole months per your state's rounding rule. The penalty START is the LATER of the transfer date or the otherwise-eligible date (exact UTC calendar), and the penalty END is start + penalty months (true month-add, month-end clamped). No API, no key, no network, no AI - every figure is exact arithmetic / calendar date math citing 42 U.S.C. 1396p(c). The penalty divisor and rounding mode are DATED / STATE inputs you confirm; a wrong state or year never silently mis-computes because the divisor and mode used are always shown. Not legal, financial, or benefits advice; exempt transfers, the hardship waiver, and trust/annuity treatment are not modeled.
Honest scope
Deterministic and citation-backed: every figure is exact arithmetic or a cited rule. Any year- or jurisdiction-indexed value is a confirmable input, never an eternal hardcode. This is a computation tool, not professional (legal, tax, medical, or financial) advice - confirm against the controlling authority for your context.
Authorities cited
- 42 U.S.C. 1396p(c) - Medicaid transfer-of-assets: an uncompensated transfer during the look-back triggers a period of ineligibility for nursing-facility / long-term-care services.
- 42 U.S.C. 1396p(c)(1)(B)(i) - 60-month (5-year) look-back period for transfers (Deficit Reduction Act of 2005, effective for transfers on/after Feb 8, 2006).
- 42 U.S.C. 1396p(c)(1)(E)(i)(I) - Penalty period = total cumulative uncompensated value transferred DIVIDED BY the average monthly cost to a private patient of nursing-facility care in the state (or community), as determined by the state Medicaid agency (the "penalty divisor").
- 42 U.S.C. 1396p(c)(1)(D)(ii) - Penalty period begins on the LATER of the first day of the month of/after the transfer OR the date the individual is otherwise eligible for Medicaid and not in an existing penalty period (DRA 2005 "later-of" start rule).
- 42 U.S.C. 1396p(c)(2) - Exceptions: transfers to a spouse, to/for a blind or disabled child, certain transfers of a home (caregiver-child, sibling-with-equity), and the undue-hardship waiver - NOT modeled here, flagged for the state agency / elder-law attorney.
- 42 CFR 435.700 et seq. - Medicaid eligibility determination framework administered by the state agency that applies these transfer rules.
- State Medicaid agency transfer-penalty divisor notices (e.g. NY DOH GIS, FL DCF ESS, PA DHS, CA DHCS, TX HHSC) - the state-published average monthly private-pay nursing-home cost used as the divisor; confirm the current figure and effective period for your state.
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Run it on your own data
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