The Medicaid look-back period

Maybe you helped a grandson with college, or gave your daughter money toward a house. Then someone mentions the Medicaid look-back period, and you wonder whether a kindness years ago could cause trouble now.

This post explains how the look-back period works, using Washington's rules as the worked example. It is part of our guide to paying for care and protecting what you leave, which covers the bigger picture.

What is the Medicaid look-back period?

When you apply for Medicaid to help pay for long-term care, the state looks back over your finances. It checks for anything you gave away, or sold for less than it was worth, during a set window.

Federal law sets that window at 60 months, or five years, for transfers made on or after February 8, 2006 (42 U.S.C. 1396p(c)). Each state applies the rule through its own regulations, and the details vary.

In Washington, the rule is WAC 182-513-1363. The window covers the 60 months before the month you both needed institutional-level care and applied for long-term care services.

Why the state looks back at all

Medicaid pays for long-term care only once your countable savings are under a limit. In Washington, that limit is $2,000 for a single person (WAC 182-513-1350).

The look-back exists so people can't simply give their savings away the month before applying. Spending your money on yourself is different, and allowed. Our post on the Medicaid spend-down explains what normal spending looks like.

What counts as a transfer

Washington looks for transfers with "uncompensated value." That means you gave something away, or you got less than fair market value for it (WAC 182-513-1363).

Some everyday examples of what the state would look at:

• A cash gift to a child or grandchild.
• Selling a car or a cabin to a relative for far less than it's worth.
• Signing a house over to someone.
• A transfer made by someone acting for you, such as your agent under a power of attorney.

The date matters. For real estate, Washington counts the transfer from the day the deed is signed and recorded, or the day the signed deed is delivered. For other assets, it's the day ownership changed.

Washington also presumes a transfer was made to qualify for Medicaid or to avoid estate recovery. You can rebut that with "convincing evidence" that it was made exclusively for another reason.

How the delay is figured

If the state finds a transfer inside the window, it does not ask for the money back. Instead, it delays Medicaid for a number of days.

Here is Washington's formula (WAC 182-513-1363):

1. Add up the uncompensated value of all the transfers in the window.
2. Divide by the statewide average daily private cost of a nursing home.
3. Round down to a whole number. That is the number of days Medicaid won't pay.

The Health Care Authority lists that daily rate as $485, effective October 1, 2026 (HCA standards). The rate in effect at application or at the transfer, whichever is later, is the one used.

When the delay starts

This surprises many families. For someone applying, the delay begins on the date they would otherwise be eligible, based on an approved application.

So the clock doesn't start on the day of the gift. It starts once savings are already down to the limit, which is when the money is most needed.

Small monthly gifts

Washington has one small allowance. If all your transfers in a month add up to no more than that daily rate, no delay applies for that month (WAC 182-513-1363).

At $485, that covers a birthday check, not a down payment. Ask before relying on it for anything larger.

Transfers that don't cause a delay

Washington lists transfers that are exempt from the penalty. Here are the main ones, in plain words (WAC 182-513-1363):

The caregiving child exception is narrow. The child must have lived in your home for at least two years and given verifiable care for at least two years.

That care must have come right before you entered care, kept you at home, and not been paid by Medicaid. A doctor must also document that in-home care was needed to keep you out of a facility.

Paying a family member for care

Paying a daughter or nephew for care can count as a fair exchange. But Washington requires seven conditions, including a documented need and a fair market rate.

Payment must also be made within one calendar month of the care. If any condition is missed, the payment is treated as a gift. This is a place where a written agreement, drafted by a lawyer, matters.

Undue hardship

A delay can be waived if, without care, a person couldn't get needed medical care, food, clothing or shelter (WAC 182-513-1367). Inconvenience by itself does not count.

One detail stands out. If the gift was made by the person handling your finances, hardship generally isn't available, unless the state finds financial exploitation. Our post on elder financial exploitation covers how to guard against that.

Here is a typical case, a composite

Ruth, 78, gave her son $20,000 three years ago to help with a new roof. This year she moved into a nursing home and her savings came down to $2,000.

The gift falls inside the 60 months. At $485 a day, it works out to 41 days without Medicaid paying, starting once she'd otherwise qualify. Her son could return the full amount, which removes the penalty, or the family could plan to pay those days privately.

Who keeps the records

An application usually means gathering statements and paperwork for the whole window. If you can't do it yourself, that job falls to the agent in your financial power of attorney or the trustee of your trust.

The look-back is also one reason a power of attorney matters. In Washington, an agent can make gifts only if the document expressly grants that power (RCW 11.125.240).

For planning done well ahead of time, see how to protect assets from Medicaid, legally. For what happens after death, see Medicaid estate recovery. And for how a standing plan keeps someone ready to handle this paperwork, see how it works.

Common questions

What is the Medicaid look-back period?

It is the 60 months before you apply for long-term care Medicaid. The state reviews that window for gifts and for sales below fair market value. In Washington, the rule is WAC 182-513-1363.

Does the look-back mean the state takes the gift back?

No. It delays Medicaid instead. In Washington, the total of the gifts is divided by the average daily private nursing home cost, $485 as of October 2026. The result is the number of days Medicaid won't pay.

When does the penalty period start?

For someone applying, it starts on the date they would otherwise be eligible, based on an approved application. It does not start on the date of the gift.

Can I give my house to my children?

A home transfer inside the window usually causes a delay. Washington exempts home transfers to a spouse, a child under 21 or a disabled child. A caregiving child or a sibling with an equity interest may also qualify, under strict conditions. Talk to an elder law attorney before signing a deed.

Do gifts more than five years old count?

Not under the look-back. Federal law sets a 60-month window for transfers made on or after February 8, 2006. Other rules, like estate recovery after death, still apply separately.

Sources

• 42 U.S.C. 1396p: Liens, adjustments and recoveries, and transfers of assets (Cornell LII)
• WAC 182-513-1363: Evaluating the transfer of assets and the 60-month look-back
• WAC 182-513-1367: Hardship waivers
• WAC 182-513-1350: Long-term care resource standards
• Washington Health Care Authority: Apple Health Income and Resource Standards, October 1, 2026 (PDF)
• RCW 11.125.240: Agent's authority over the principal's property