The Medicaid Look-Back and Spend-Down
Medicaid examines a five-year window before an application, looking for gifts and property transfers, and one found there creates a penalty period that starts only once the money has already run out. Here is how that works, how fast a spend-down happens, and a printable worksheet. Not legal advice — your state agency decides.
Works offline — your inputs never leave this device. How that works
This is an explanation, not legal advice
Medicaid long-term care rules are set state by state, they change, and the way they apply to one family turns on facts a website cannot see. Nothing here decides anything. Your state Medicaid agency is the only body that can, and an elder-law attorney is the right person to ask before money or property moves anywhere.
What the look-back actually is
When someone applies for Medicaid to pay for long-term care, the state examines a window of time before the application and looks for money or property given away, or sold for less than it was worth. Federal law sets that window at 60 months — five years — for nursing facility care, and states apply their own rules to home and community based waivers.
It is not a tax and it is not a fine. What a transfer inside the window creates is a penalty period: a stretch of time at the start of care during which Medicaid will not pay, worked out by dividing what was transferred by a monthly figure your state publishes for what nursing home care costs there.
The part that catches families out
The penalty period does not begin on the day of the gift. It begins on the day the person is otherwise eligible — which is to say, in care, applied, and out of money. So the ineligibility lands at the exact moment there is nothing left to pay with.
That is why "we gave the house to the children years ago, it will be fine" is the single most expensive sentence in this subject, and why it is worth asking before rather than after.
What a spend-down is, and how fast it happens
Medicaid is needs-based, so it begins once income and countable assets are inside the limits your state sets. Getting there by paying for care out of savings is what people mean by a spend-down. It is not a loophole and it is not avoidance — it is simply what happens when care costs more per month than a household takes in.
Nursing home, shared room — national median
$9,581 a month
Survey prices collected for 2025
Illustrative savings
$100,000
A round number, not a limit
How long that lasts
about 10 months
Before any income is counted against the bill
Our arithmetic, not the survey's: $100,000 ÷ $9,581 a month. Income reduces the drawdown, a private room raises it, and a state above the national median shortens it further. The point of the sum is the order of magnitude: a spend-down is usually measured in months, not years, which is why families meet Medicaid far sooner than they expect to.
Where these figures come from, and what they are not
This median come from an industry survey of providers, not from a government rate table. No federal agency publishes one, which is why the survey is the source of record here and why we label it plainly instead of dressing it up as official.
A median means half charged more and half charged less. It is not a quote, no provider is bound by it, and prices vary widely between one town and the next. Prices were collected for the 2025 survey: CareScout Cost of Care Survey ↗.
Four things people get wrong
The gift-tax allowance has nothing to do with Medicaid
The amount the IRS lets you give away each year without filing a gift tax return is a federal tax rule. Medicaid is a different program with different rules and does not recognize it at all. A gift that is invisible to the IRS is fully visible to a Medicaid caseworker.
Paying for your own care is not a transfer
Spending your money on your own care, your own home, your own debts and your own living costs is not giving anything away. The look-back is aimed at value that left the household for less than it was worth, not at money that was spent.
Some transfers are exempt, and the list is specific
Federal law exempts certain transfers outright — to a spouse, to a child who is blind or has a disability, and in defined circumstances to a caregiver child or a sibling with an equity interest in the home. The conditions are precise and the proof required is real. This is exactly the territory where an attorney earns their fee.
The home is not always countable, and is not always safe either
A primary home is often not counted while the person is applying, particularly where a spouse still lives in it. That is a different question from whether the state can recover against it afterwards, which most states must attempt. Two separate rules, routinely confused.
The worksheet — print it and use a pen
This is what an elder-law attorney or a state caseworker will ask for. Gathering it before the appointment is worth more than any calculator, and it is why there is nothing to type on this page: none of it belongs on a website, including ours.
1. The five-year window
Write the date of the application you expect to make, then count back sixty months. Every question below is about what happened between those two dates.
Expected application date, and the date sixty months before it
2. Money or property that left
Gifts, loans to family, a car signed over, a house put in someone else's name, a property sold below its value, money moved into a trust, help with a grandchild's tuition or wedding. Date, amount, who received it, and why.
Each transfer: date · amount or item · who received it · reason
3. What is owned now
Checking, savings, certificates, investments, retirement accounts, life insurance with a cash value, a second vehicle, land, a burial fund. Note whose name is on each one.
Each asset: what it is · roughly what it is worth · whose name
4. Income each month
Social Security, pensions, annuity payments, rent received, wages. Both spouses, listed separately, because states treat a couple's income differently from one person's.
Each source: what it is · monthly amount · whose name
5. The paperwork to find
- Sixty months of statements for every account
- Deeds and titles, including any transferred
- Trust documents, and any power of attorney already signed
- Life insurance policies, with their current cash value
- Marriage certificate; death certificate for a late spouse
- The current care agreement or facility contract
What is still missing, and who is getting it
6. Questions for the appointment
Write them down before you go. Every family forgets at least one, and the good ones are usually the awkward ones.
Questions
Nobody should be selling you a solution to this
A trust, an annuity or an insurance policy sold as a way to "protect assets from Medicaid" is a product with a commission attached, and the transfer it involves is the exact thing the look-back is designed to find. If a sales conversation and a Medicaid conversation are happening in the same room, leave the room.
An elder-law attorney charges a fee and sells you nothing. That difference is the whole point of paying one.
Who to ask about the look-back
The state agency decides; the attorney tells you what a move will do before you make it; the free counselors and the area agency on aging fill in everything around it.
- Eldercare Locator — 1-800-677-1116 ↗Free
Run by the federal Administration for Community Living. Give them a ZIP code and they connect you to the area agency on aging that covers it, which is the office that knows what exists locally.
- Your State Health Insurance Assistance Program ↗Free
One-to-one counseling on Medicare, Medicare Savings Programs and Extra Help, from someone paid by a federal grant rather than by commission. The local name differs by state — HICAP in California, SHINE in Florida, SHIBA in Washington.
- Medicaid.gov — eligibility policy ↗Free
The federal rules Medicaid long-term care sits inside. Your own state agency administers them and is the only body that can decide your case.
- VA — find an accredited representative ↗Free
VA's own search for accredited Veterans Service Organization representatives, attorneys and claims agents. VSO representatives help with pension and Aid and Attendance claims at no charge.
- National Academy of Elder Law Attorneys ↗Directory is free; the attorney is not
Where to find a lawyer who does this work full time, if a transfer, a trust, a house or a second marriage is involved. Attorneys charge; asking one before you move money is usually cheaper than asking one afterwards.
Our own who to ask page sorts these by situation, and the paying for care hub holds the rest of this wing.
Verified 2026-08-02 against CareScout (formerly Genworth) Cost of Care Survey 2025, fielded July-November 2025 (effective 2026-01-01)— an industry survey, not a government figure. Why we use it.
Estimate only — not financial, tax, legal, or insurance advice. Only your state Medicaid office can determine your actual amounts.
Official source: Medicaid.gov — eligibility policy (your state agency decides) ↗
🎓 Understand this tool
What it is
Explains the window Medicaid examines before a long-term care application, the penalty period a transfer inside that window creates, and what a spend-down actually looks like. It ends in a worksheet built to be printed and filled in with a pen.
How it works
Federal law sets a sixty-month look-back for nursing facility care, and a transfer for less than fair value inside it produces a penalty period worked out from a monthly divisor each state publishes. Because the limits, the divisor and the treatment of a home are all set state by state and change every year, this page carries no state figures at all and defers to the agency instead.
Getting the most from it
- Read the mechanism first, especially when the penalty period begins — that timing is what catches families out.
- Look at the spend-down arithmetic to get the scale. It is usually measured in months.
- Read the four common misunderstandings. At least one of them is probably in your head already.
- Print the worksheet and fill it in by hand before any appointment.
- Take it to your state Medicaid agency, and to an elder-law attorney if property or a transfer is involved.
Reading your result
The spend-down figure on this page is illustrative arithmetic at a national median, shown to convey the scale rather than to describe your case. The worksheet is the real output: the questions on it are the ones a caseworker or an attorney will ask, and having the answers written down beforehand is worth more than any calculator on this website.
What it can't tell you
This is an explanation, not legal advice, and the page holds no state figures because those change annually and belong to the agency that sets them. It cannot tell you whether a particular transfer will be penalized, whether an exemption applies, or what your state counts. Your state Medicaid agency is the only authority on your case, and an elder-law attorney is the right professional for anything involving a house, a trust or a transfer.
Frequently asked questions
Federal law sets it at sixty months — five years — before the application for nursing facility care, and states apply their own rules to home and community based waivers. Your own state agency is the only place to confirm which window and which rules apply to your situation, because they administer the program.
Related calculators
Funding Screener
Seven questions, none of them about who you are, and the answer is a list of offices rather than a verdict: Medicare Savings Programs, Medicaid long-term care, VA pension, your free state counselors, the area agency on aging, and an elder-law attorney if property is involved. Each one names who decides and what to bring. Estimate only, never a determination.
Care Costs
What in-home care, adult day programs, assisted living and nursing homes cost in your state, converted to monthly and yearly figures from the hours you actually expect to use. The survey publishes each kind of care in a different unit, so the arithmetic that makes them comparable is ours, and it is printed beside every number. Estimate only.
Aid and Attendance
Aid and Attendance is paid as the gap between a maximum yearly pension rate and your income for VA purposes — and unreimbursed medical expenses above five percent of that rate come off your income first. This estimate shows both figures, so you can see why people in assisted living qualify. Not legal advice; accredited representatives help free.
Savings Programs
Four programs pay the Medicare premiums of people with limited income, and a fifth pays most drug costs. Answer two questions to see where your figures sit against the federal limits for QMB, SLMB, QI and QDWI, plus Part D Extra Help. Those federal numbers are a floor many states exceed, so this is an estimate, never a decision.
Annual update alerts — new tax and benefit figures the week they drop
One email when the numbers change. Double opt-in, no spam, unsubscribe anytime.