transferDecember 5, 2013 —  ‘Tis the season for holiday gifting.  Between Hanukah and Christmas more gifts are given in the United States than any time throughout the year.  I thought it only appropriate to do a reminder for all the advisors out there on how the gifting limits for Medicaid can turn grandma’s good intentions into the Nightmare Before Christmas.

Gifting away assets can cause serious problems when attempting to qualify for long-term care Medicaid.  The punitive Medicaid asset transfer rules are one of the harshest and cruelest rules ever imposed by the government against its ailing seniors.  An improper transfer can cause serious penalties that can leave a patient’s family scrambling to figure out how to cover the cost of long-term care.



Improper gifting can come in a number of different ways:

  • Giving away an asset to someone who is not an exempt recipient;
  • Selling an asset for less than its fair-market value;
  • Adding a person’s name to an asset (For example: adding your children as joint owners on your property deed);
  • Purchasing an annuity which is not Medicaid compliant;
  • Paying a child for home care or assistance without a valid personal service contract;
  • Making a loan to a friend or family member with a promissory note that is not Medicaid compliant; or
  • Refusing to take an inheritance that is left to you through a will or a trust.



Many people get confused and think that the $14,000 per person, per year gift tax exclusion is the allowable gifting limit for Medicaid transfers.  We frequently find that people give assets away under the misconception that if the gifts are less than the $14,000 gift tax limit, they will not be penalized if the need arises for long-term care Medicaid.  While some states do overlook de minimis gifts (i.e., small gifts usually under $500 or a pre-set limit that the Medicaid caseworker is allowed to overlook), all improper transfers within the look back period are added up and used to determine the penalty period. 

For example: A grandmother decides to gift each of her four grandchildren $14,000 a year thinking that it will not cause a penalty. She has been doing this for the last seven years and now needs long-term care.  Once she is eligible for apply for Medicaid, the state will ask for disclosure of all transfers within the look back period.  In this case, she’s gifted $56,000 a year in each of the look back years, for a total of $280,000.  In most state, she would be ineligible for Medicaid for well over three years after she’s otherwise broke. [Note: If you were the advisor who told her it was OK to gift her money to the grandchildren, you’re overdue to take my Medicaid Planning Course.]



The Deficit Reduction Act of 2005 expanded the look back period from 3 years to 5 years.  Almost every state has adopted this or is in the process of adopting this rule.¹

The look back period is based upon when a person applies for Medicaid and is “otherwise eligible.”  To be “otherwise eligible,” a person must:

  • be in a care facility that accepts Medicaid payments and medically need the care;
  • not have enough income each month to pay for the cost of care; and
  • qualify financially – the patient’s available resources (i.e., those assets that count towards eligibility) must be below the state resource limit which is usually $2,000 in most states for a single patient and varies for married couples.

So essentially the patient has to be broke before a penalty period can even start.

Because the look back period includes all five years prior to filing the Medicaid application, it is possible to file a Medicaid application too early!



Not only are the gifting rules difficult to understand, but the penalties associated with the gifts are cumbersome to say the least.

Penalty periods start when the patient is otherwise eligible.  They are calculated by adding up all the gifts within the last five years prior to the Medicaid application. Each state must determine the average cost of care in the state or by region and use that figure each year to set the penalty divisor.  The total gifts are divided by the penalty divisor and used to determine the total number of days of ineligibility.

Some states use a daily divisor and some use a monthly divisor.  Those that use monthly divisors cannot round up or down and must pro rate the month.

Monthly Divisor Example:  The patient has gifted $49,000 over the last five years and the monthly penalty divisor in his state is $6,350.  To calculate the penalty period, divide $49,000 by $6,350.  The total penalty period is 7.71 months or 7 months and 21 days.

Daily Divisor Example: A patient has gifted $33,000 over the last five years and the daily penalty divisor in her state is $224.  To calculate the penalty period, divide $33,000 by $224.  The total penalty is 147 days or roughly 5 months of care.



If someone has given away money that cannot be recovered they can ask the state for an undue hardship waiver so that Medicaid will waive the penalty period.

The requirements to get an undue hardship waiver have been set very high. Most states require that all legal options be fully pursued to recover the improperly transferred assets.  A person requesting a hardship exhausted all legal remedies to collect, re-convey, or recover the improperly transferred assets.  By legal remedies, that usually means that the patient (or the patient’s agent) must legally pursue a claim against any person who received the moneys and attempt to get them back.  For the lady in the example above who gifted $14,000 a year to her grandchildren, that means have to sue each of the grandchildren to try to get the money back before the state will even consider granting her an undue hardship waiver.



There are several silver linings to the punitive long-term care Medicaid asset transfer rules that you should have in your playbook:

  • REVERSE HALF-A-LOAF: The rules allow for curing a penalty by re-conveying assets.  This can be helpful when trying to protect assets for a single individual because a portion of the assets can be returned to pay for care while a portion are retained by the gift recipient.  Often this can lead to a savings of approximately 50 to 55% of the total asset amount.  This does not work in all states because some states require ALL assets to be returned before they recalculate the penalty period.
  • HALF-A-LOAF AND MEDICAID QUALIFIED ANNUITY: The ability to gift about half of the asset base away and pay through the penalty period with a Medicaid Qualified Annuity is a strategy that is rather helpful. The penalty period causes the patient to pay privately for a period of time.  The use of the Medicaid Qualified Annuity can take the other half of the assets and convert them into an income for that same period of time.  As long as the total of all incomes are still less than the cost of care, the penalty period starts to run. 
  • EXEMPT GIFTS:  Not all gifts are considered improper transfers.  Some people can receive unlimited gifts without triggering a penalty period. Additionally, gifts not made in anticipation of qualifying for Medicaid can be challenged on the basis that they were not intending to artificially impoverish the patient for Medicaid eligibility purposes when there was no likelihood that the patient would need care at the time of the gift. 
  • PLANNING AHEAD: For people who want to be prepared, it is often very helpful to use the gifting rules to your advantage. Only gifts within the 5-year look back period are counted.  Gifts of any size prior to that are ignored completely.  While some choose to give gifts to a person, often the gifts are put in a special Medicaid gift trust where they are preserved.  Those who worry about making it five years after they transfer assets often use investments (i.e., annuities or life insurance) in the trust with long-term care riders that will help privately pay for care if they need it before the five-year look back period has expired. 

You can stop the Grinch from stealing grandma’s Medicaid!  Through our mentoring program and case design assistance, we can assist you with gifting strategies that can maximize your client’s asset protection and minimize improper transfer penalties.  We can also show you how to provide advocacy with the Medicaid department to help with fair hearings and requests to have asset transfer penalties waived.  If you want to learn Medicaid Planning you should check out my Medicaid Planning Course or my comprehensive Medicaid Planning Guidebook.  Also, I’d be remiss if I didn’t mention the Certified Medicaid Planner™ designation which can help advisors in the field of Medicaid Planning set themselves head and shoulders above the rest in the field.

For more information, please contact me at: and have a Happy Holiday Season from the team at


¹It should be noted that California has not adopted the 5-year lookback or the change to the start of the penalty periods.  In 2012 the state proposed adopting the federal requirements but never completed the process of formally adopting the proposed rules.  If you require additional guidance on transfers under the Medi-Cal rules, please email