Are there exceptions to the Medicaid lookback in Texas?

I think part of the issue with your post is that “exception / exceptions” imo is not used for the LTC Medicaid eligibility application. “Exemption” tend to be used in Estate Recovery’s after death attempt to recoup costs paid.

In my experience there are not exemption or exception done to do away with 5 yr financial lookback. (Fwiw If elder has been private pay in a facility for a while may be just a 3 yr lookback). State has to have documents requested so that a determination is done as to whether or not a financial transaction is OK or not OK. LTC Medicaid has very narrow financial path and this is what that stack of documents has to provide for. If documents show something definitely wonky, it’s not ok, so then a transfer (of assets) penalty is placed onto the applicant. They will not be eligible for LTC Medicaid till past a transfer penalty period (will be a fixed # of days).

The individual applicant or POA flat has to provide for the documents the State - via the caseworker - has to review in order for application to be processed to determine if the applicant is rightfully “at need” financially. Which for TX is income max of $2,901 & nonexempt assets at 2K max. And that they’re now being at a mere 2K in nonexempt assets makes sense. This is what all those documents are about…. it’s establishing that 1.a they’re now being at under 2K in savings/assets in their bank account is ok AND 1.b they are paid under $2901 a mo from SSA income and any other resources AND 2. that they do not have any assets they can cash in (whole life insurance policy) AND 3. they did not do any gifting of $ or assets (home, cars, $, land) to others within the past 5 years that are beyond acceptable for the elders eligibility.

Usually for TX the NH will provide for a list of items that need to accompany your elders LTC Medicaid application. For TX what tends to happen is the NH will themselves do a quick review of that stack of financial and asset ownership stuff (like last Tax collector bill if they have a home) so that the NH can decide if - IF - they will accept the new resident as a Medicaid Pending Resident for billing and roughly what that new resident Share of Cost paid to the NH will be as of Day 1 (which the NH is expecting to be paid as of date of entry as custodial care resident). Then NH sends all your documents along with their bill to the State via the caseworker assigned to that zip code/region.

The 5 yr review on banking tends to be every monthly statement past 12-24 months and then beginning and end of the year for the 3 years earlier. If in the 12-24 are checks or withdrawals or deposits that seem odd, then the caseworker will want an explanation as to what a deposit was &/or why $ was an appropriate spend (it was not a gifting of assets).

Lets say elder gets $1500 in SSA, is in rehab at a NH but was living with family and now is at 2k in assets and is “medically at need” so will stay in the NH/SNF. Bank statements show 3 years ago they paid $29,876 to a car dealership but State records show no vehicle in their name, then shows them paying 20K Uni tuition every fall past 5 years; then last year they wrote a check for $15,000 to a wedding caterer and this year they paid the son they live with $750 every month. The $750 a mo is ok as it’s viewed as cohabitation costs. But all the other $ is “gifting”. So elder gets a 145K transfer of assets penalty placed on their LTC Medicaid application. Their State pays the NH $200 a day. So they have about a 725 day / almost 2 years penalty period that LTC Medicaid will NOT pay. They will have to have family private pay or they move back to live with family.

If you have anything similar to this going on OR y’all have been commingling elders income and your own income, imo dealing with TX LTC Medicaid application is not a DIY. Find an elder law attorney experienced in LTC Medicaid & transfer penalties. Ideally before the elder ever becomes a NH custodial care resident.

The is an elder care/Medicaide attorney in Houston, Michael Holland who will help quite a lot before he ever charges. He basically will explain everything and you pay him only when he prepares documents. He was a life saver for our family. I talked to him for at least a couple of hours before we hired him.

Medicaid look back in most States is 5 years. California maybe 3? There are no exceptions I am aware of. You must show that no large sums of money were gifted. If they were, there will be a penalty period depending on how much money was gifted. Trusts should not be done within that period.

Each State is different in how Medicaid is handled. I would contact your County Social Services office and make an appointment with a Medicaid caseworker and ask them your questions. You will get better answers there than from a forum of people from all over the US.

As you can see from the intricacies of Igloo's response, this is all very very complicated. Instead of reaching out to a Forum of strangers who may or may not have all the answers I would be certain in issues that involve qualifications and recovery to consult an attorney. I understand this is expensive. Ask for a payment plan. Because in cases where expert advice is concerned you just must have someone in the "know" and that means expert advice whether medical, legal, of financial.

Folls that are caregivers for going in 6 yrs health themselves are an issue. I don't understand what this means, can you please clarify and also provide other information: Is your question about qualifying? Or MERP (estate recovery after the recipient has passed away)? What is causing the current desperation? Are you the applicant or the caregiver/PoA to an applicant? Is this your spouse, parent, other? How old are they? What are the health/cognitive issues? Has a person's funds been mismanaged and this is why you are trying to get an exception to the lookback? Why do you think your situation could somehow be exempt from the rules that are applied to everyone else? FYI in most states Medicaid covers 100% of the medical portion of a person's LTC -- and only LTC, not AL or MC. A person needs to medically qualify (assessed by a doctor) to need LTC. Then, as you apparently know, they also need to qualify financially. Their SS income covers 100% of their custodial care (room and board).

There are several exemptions & exclusions to Estate Recovery, as well as a cost benefit analysis that factors into whether or not a recovery attempt is done. The “caregiver exemption” is the one that most know about. But there is one for low-income heir, disabled heir, heir over @ certain age (like home is left as per the now deceased will to an aged sibling). State of TX DADS website should have exemptions & exclusions details. It’s also in the State administrative code.

Retaining home imho can be done, but may be challenging. I’ve been on this forum a long time & what tends to be the biggest challenge is:
1. that there is no $ to pay for the costs on the home that remains in the name of a now-in-a-NH-elder-on-LTC Medicaid, so the home ends up getting sold;
and
2.a. there is more than 1 heir and there is no agreement as to just how the house is to be dealt with among the heirs (and often more importantly their spouses). 2.b. one of the heirs has been the caregiver, so has not been working, and often finds themselves to be “at need” financially, so they cannot afford the costs to have a home.

#1 is due to the LTC Medicaid Share of Cost requirement. If you are unfamiliar with this, it is that all the elders monthly income less only $75 has to - HAS TO- be paid to the NH every month. The $75 is their PNA personal needs allowance BUT is is “delineated spending”, which means it has to be used for things that are not covered by LTC Medicaid, so it’s used to pay for beauty / barber shop, in room cable, clothing replacement. It cannot be used to pay any cost on their home as their room&board is covered by TX LtC Medicaid. So all costs on that house - still in the elders name - has to be paid in some way. In theory costs are all paid by the potential heirs on that house. So property taxes, utilities, maintenance, insurance, etc will have to be paid by you & other heirs till beyond the elders grave, as any transfer of title will not happen till after the elder dies. If there is a mortgage, this could be a tidy sum as mortgage requires the property to be fully & properly insured for whatever perils in your part of the State. So is the $ there to do this and probably pay for years & years?

It is not legally yours, so you cannot get lending on it. You have to have the $. If homestead exemption gets pulled, property taxes will increase dramatically. TX property taxes are high, not quite NJ high, and are significantly higher than what most States do.

On #2, the exemptions - in my understanding - tie into the position of all the heirs based on the will. If there are 4 kids & equal heirs, then each has to qualify for one. And if there are several heirs, they may not be in agreement as to paying current house costs based on their supposed future % ownership share. If 4 sibling's as equal heirs, and 2 refuse to pay a penny, you cannot make them and you cannot change the will.

Even if elder does a Lady Bird Deed or does a Testamentary Trust, the potential heirs have to be able to pay all property costs - and likely for years - if the elder is in a NH on Medicaid. It can be done, imo it’s like having a second home, but one that you do not actually legally own so it runs risk that things may not turn out as anticipated.

On this forum, there have been caregivers who fully qualify for exemptions, but did caregiving for free for years and flat do not have the $ to afford household expenses. & family who are all gung-ho on keeping the home initially but run out of interest and refuse to pay for any property costs or do anything they said they would. If property taxes are not paid, the County will put it up for tax sale.

There is always a way forward, we would need more specific information here to better advise. Usually, I would recommend getting the help of a social worker, either from the hospital network or at the state level.