Many lawyers doing Medicaid qualification for their clients often get confused between the snapshot date and lookback date. These dates are not only confused by lawyers, but also often by the Medicaid departments processing the application. So let's set it straight. 42 US 1396r-5 (c) states the snapshot date occurs on the first day of the month in which a Medicaid applicant reached thirty days of "continuous institutionalization". Continuous institutionalization is identified as thirty consecutive days in an institution of care. These include hospitals, nursing homes, VA facilities, or the like.
If an individual enters a hospital on January 15, is discharged on January 30, enters a nursing home on February 5, and applies for Medicaid on March 1, no snapshot date has occurred. Why? It's simple. Thirty continuous days of institutionalization has not occurred by March 1. By virtue of the discharge from the hospital on January 30 and readmission to the nursing home on February 5, a lag occurred, restarting the 30 day period. Since they entered the nursing home February 5, and applied March 1, no snapshot date is set because thirty continuous days has not occurred.
Continuing, if the client stays in the nursing home through March 5, then the snapshot date would be February 1, the first day of the month in which the applicant entered a facility for thirty days of continuous institutionalization. The significance of the snapshot date is it represents the date Medicaid will look at all financial assets owned by the Medicaid applicant and spouse in determining whether or not they are eligible for benefits. In this case, Medicaid would take a "snapshot" of all assets owned by the applicant and spouse on February 1 and use this information to determine the client's individual resource allowance, the community spouse resource allowance, and the client's net available monthly income that can be used for the cost of care.
What makes all this confusing is, although the federal statute is clear as outlined above, most states treat the “lookback date”, as the "snapshot date." The lookback date is entirely different; it is the date when applicant resides in a nursing home AND applies for Medicaid benefits. In this case the lookback date does not occur until the Medicaid applicant applies for Medicaid. Since they are already in the nursing home, they would have to apply for benefits to establish the lookback date.
In this case, if an application was filed, the lookback date would also be March 1, the first day of the month of application after admission. In many cases clients come to you long after the snapshot date and in many cases may have been residing in a nursing home for many, many months, before they apply for Medicaid so no lookback has been established. The lookback date has a use and different significance than the snapshot date. While the snapshot is used to calculate all the allowable exemptions, the lookback date is used to establish the date at which Medicaid will look back sixty months at all financial data of an applicant to determine if there were any uncompensated transfers.
Understanding these key definitions is critical in having an effective Medicaid practice, but more importantly, to get your clients confident they will be eligible in the timeframe you identify. To learn more about Asset Protection and Medicaid Planning for your estate or elder law practice, consider joining us next week in Charlotte, NC, for our Practice With Purpose Program. We'll be covering this and so much more just on Day 1! We'll also be allowing a test drive in the room to review our drafting software!
David J. Zumpano, Esq, CPA, Co-founder Lawyers With Purpose, Founder and Senior Partner of Estate Planning Law Center
So is the snapshot date the first day of the “month in which a Medicaid applicant reached thirty days” or is it the “month in which the applicant entered a facility for thirty days”? Is it February 1 or March 1 in your example? You state both.
It appears that the snapshot date could be years before the lookback date, which makes little sense, like many government rules. Determining exemptions years before the application seems strange.