Medicaid Look-Back Period in New York: 60 Months for Nursing Homes, and the Home Care Rule That Has Not Started

What is the Medicaid look-back period in New York?

The look-back period is the window of past financial transactions a Medicaid office reviews when someone applies for nursing home coverage. New York’s Social Services Law sets it at the sixty-month period immediately before the date a person is both institutionalized and has applied for Medicaid. In practice the local district, which in New York City is the Human Resources Administration, asks for bank and account statements covering that window and looks for money or property that left the applicant’s hands for less than it was worth.

The look-back is not a ban on spending. Paying rent, buying groceries, paying a home health aide at a fair rate, or replacing a roof are purchases at fair value and create no penalty. What the district looks for are gifts and below-value sales: a check to a grandchild, a house deeded to a son for a dollar, a car signed over to a neighbor. Each one has to be explained, and the ones that are not exempt are added up.

The phrase people search for, the “five-year rule,” is the same thing: 60 months is five years.

How the transfer penalty is calculated

The state law spells out the formula. The total uncompensated value of the transfers is divided by the average monthly cost of nursing home care for a private patient in the region. The result is the number of months Medicaid will not pay for nursing home care. Each January the Health Department publishes the regional figures in a General Information System message. For 2026 it is GIS 25 MA/14, which says the rates are based on average private pay nursing home costs in each of the seven regions.

The district uses the rate for the region where the nursing home is, in effect on the date of application. A worked example with the New York City figure: a $50,000 gift divided by $15,282 is about 3.3 months; a $100,000 gift is about 6.5 months. Ask the district in writing how it treats the fraction of a month in your case.

When the penalty starts, and why the timing hurts

Under the state statute, the penalty period begins on the later of two dates: the first day of the month in which the assets were transferred, or the first day the person is otherwise eligible and receiving nursing home care under an approved application. For almost every family it is the second date.

That means the clock does not run quietly in the background after a gift. It starts only when the applicant is in the facility, has spent down to the resource limit and has applied. During the penalty months the bill is still owed, the money that could have paid it has already gone to the relative, and Medicaid will not pay. This is why a transfer made with good intentions three years before a fall becomes a crisis the week of a hospital discharge.

Two ways a penalty can shrink or end: the relative returns the full amount, which the statute treats as erasing it, or the applicant shows undue hardship, meaning that denial would endanger health or life or leave the person without food, shelter or other necessities. Both are argued with the district and, if refused, at a fair hearing.

Which transfers do not cause a penalty

The statute lists transfers that do not count against eligibility. These are the main ones, stated as the law states them and not as planning advice.

The caregiver-child row is the one families use most and prove least. It needs evidence: the child’s address history, a doctor’s statement that the care was needed, and a record of what the child did. Gather it before the deed is signed, not after.

Does New York have a look-back for home care?

Not yet in operation. In 2020 the Legislature added a 30-month look-back for people applying for community-based long-term care: personal care, home health care, CDPAP, adult day health care, the Assisted Living Program and Managed Long Term Care while living at home. The state’s own waiver request said the earliest it would seek to start was March 31, 2024.

It has not started. NY Health Access, the Legal Aid reference service, reported on February 2, 2026 that there was no start date, that federal approval of a State Plan Amendment and a waiver amendment was still outstanding, and that the state had not issued the directives and forms local offices would need. We found no later state directive when we checked for this page in November 2026. Applications filed before any start date are not subject to it, according to the state’s submission to the federal government.

Three groups would be outside the 30-month rule even after it starts: people in mainstream Medicaid managed care, people whose Medicaid is decided under MAGI income rules, and participants in the NHTD and TBI waivers, which the state’s request does not cover.

The spouse who stays at home

When one spouse enters a nursing home, or enrolls in an MLTC plan or a waiver, the other spouse is protected by the spousal impoverishment rules. The Health Department’s 2026 notice sets the numbers:

The house, household goods, a car and certain burial funds are not counted. Either spouse can ask the district for an assessment of the couple’s resources at any time, even without applying; in New York City the notice points to the HRA Medicaid Helpline at (888) 692-6116 and to form DOH-5298.

What spousal refusal means in New York

New York lets a community spouse refuse to make resources above the allowance available. The 2026 state notice spells out the consequence. The institutionalized spouse is not found ineligible if they sign an assignment of support to the district, or cannot sign because of impairment. The district or the Health Department may then go to court against the community spouse to recover what Medicaid paid.

A separate point people confuse with it: the community spouse must still provide information about their resources. Refusing to give information, as opposed to refusing to give money, is a reason to deny the application unless undue hardship applies, for example when the spouse’s whereabouts are unknown. On income, the district asks a community spouse with income above the allowance to contribute 25% of the excess, and the spouse can ask for a conference to negotiate it.

A checklist before any money moves

What to say when you call the district to check the rate in use:

“Which regional rate are you using to calculate a transfer penalty for a nursing home in New York City for an application filed this month, and how do you treat a partial month?”