Preserving & Protecting Your Family’s Assets & Legacy

Chronic Care Medicaid pays retroactively

by | Jul 10, 2023 | Medicaid Planning |

Chronic Care Medicaid is a program that covers long-term nursing home care, subject to a 5-year asset lookback (see What is the Five-Year Lookback for Medicaid? for more details). The timing of the application submission for Chronic Care Medicaid is crucial. If the Applicant’s resources are within allowable limits, Medicaid will cover expenses retroactively up to 3 months before the month of application. This allows Applicants time to gather required documents for their application and provides a grace period to those who didn’t apply immediately.

Here’s a common scenario for using this retroactive payment period:

  • A patient enters a nursing home/rehabilitation center on January 1st, and their Medicare covers rehabilitation costs fully until January 20th (20 days).
  • The patient continues to make progress with rehabilitation, and Medicare covers them for another 80 days with a co-insurance of $200/day, which the patient’s Supplemental Medicare plan covers. Medicare’s final covered day is April 11, 2024 (100-day max).
  • The Medicaid “pick-up date” (the first day that would be private pay) is April 12th. The patient can apply for Medicaid coverage until July 31st to receive coverage beginning on the “pick-up date” of April 12th.

The application would request Medicaid to cover nursing home expenses dating back to the “pick-up date.” However, if the application is submitted after August 1st, the coverage can only go back to May 1st (3 months prior to the application month).

In cases where a client has made a transfer in the past, this retroactive period may save them 3 months of private pay (see Medicaid Look-Back Can Be Reduced to 57 Months).

It’s advisable to consult an experienced elder law and estate planning attorney before paying nursing home bills privately. If you or a loved one needs long-term care services, contact an attorney who specializes in this area of law immediately.


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