Transfers of Property

Look-Back Period

The Look-Back Period is 30 months during which an individual cannot transfer certain property to others or set up certain types of trusts in order to qualify for MC. Any Disqualifying Transfers made during the Look-Back Period could result in a Period of Ineligibility for LTC services.

• The Look-Back Period for applicants in LTC is 30 months immediately prior to the application date (or first retro month, as applicable).
• The Look-Back Period for continuing clients who later enter a nursing home is 30 months immediately prior to the month of admission to an LTC facility.

If the client answers ‘Yes’ to the “Have you or anyone in your household sold, traded, given away, or transferred a resource in the last thirty (30) months?” (question #24 on the SAWS 2 PLUS) on their application, request verification to determine whether the transfer was disqualifying or not.

If a client indicates on his/her application that they did not transfer property in the last 30 months, no review is required. The EW should document that the question was asked and the client responded “No”.

If existing information in CalSAWS (existing property or information from the Income and Eligibility Verification System) shows that a transfer may have occurred, the EW should contact the client and get verification that a transfer did not occur. For example, if the case history showed that the client owned two homes, but their current application does not list any property, that property may have been transferred within the 30 month look back and verification should be requested.

 

Important: Counties shall not request verification or review electronic asset verification information regarding transfers of property made, or calculate any periods of ineligibility for transfers made on or after January 1, 2024, for LTC applicants, MC members, or their spouses. This includes transfers of lump sums and income streams, such as mortgages, loans, and annuities. Transfers made prior to January 1, 2024, continue to be subject to the transfer of assets rules. Individuals must be reviewed for undue hardship before imposing a period of ineligibility. 

Disqualifying Transfers

A disqualifying transfer exists when:

• The EW cannot establish a basis for exempting the transfer, or
• There is no basis for undue hardship, or
• The LTC individual has given the property as a gift, or
• The LTC individual did not receive Fair Market Value (FMV) or other equally valuable consideration for the transferred property.

Once a disqualifying transfer exists, the EW must:

• Determine the Period of Ineligibility (POI) for LTC services,
• Determine if there is a resulting overpayment, and
• Follow the POI procedures
• Effective 1/1/97, an individual who knowingly and willfully makes a disqualifying transfer which results in a POI may be subject to criminal penalties.

Note: If it appears that a person in LTC is being exploited and there is no other relative to contact, the EW should make a referral to Adult Protective Services (APS) and contact the LTC Ombudsman.

Non-Disqualifying Transfers

The following transfers, before or after admission to an LTC facility, do not result in a period of ineligibility for LTC services:

• Exempt Property
• Transfer of the CSRA to a Community Spouse
• Property the client sold for Fair Market Value (FMV) or intended to get FMV
• Non-Exempt Property that was transferred to the following:
  • Community Spouse
  • A blind or permanently disabled child of the LTC individual
  • Prior to the admission to an LTC facility, to the spouse/same-sex spouse/RDP (or as of the date of the transfer, to another for the sole benefit of the spouse/same-sex spouse/RDP), provided that the spouse/same-sex spouse/RDP did not transfer the property to another person for less than its fair market value.
• Non-Exempt Principal Residence when transferred to:
  • A Community Spouse
  • The LTC individual’s child under 21
  • The LTC individual’s child who is blind or disabled
  • The LTC individual’s sibling who has equity interest and who lived in the home for one year immediately preceding the institutionalization of the individual.
  • The LTC individual’s child over 21 who lived in the home for two years immediately prior to the date of institutionalization and who provided care to the LTC individual which delayed that individual from going to a nursing home.
• Undue Hardship. Undue hardship exists when the LTC individual is otherwise eligible for MC and is unable to obtain medical care without MC and any of the following is true:
  • The LTC individual was incompetent at the time of the transfer (verification of incompetency from Physician is required)
  • The LTC individual was competent but there is evidence they were influenced to transfer the property
  • The LTC individual is being threatened with eviction from the facility when eviction would increase his/her medical problems. A physician’s statement is required as verification. There must also be verification that the person who received the transferred property no longer has it and cannot obtain it.

Hospice Care

An applicant or recipient of a hospice program must not be made ineligible for nursing facility level of care due to a disqualifying transfer, even though he/she may be receiving hospice program benefits in a nursing facility. That means, POI rules do not apply for individuals in a hospice program.

Note: A terminally ill person may choose to receive hospice care instead of treatment directed at curing the illness. The patient signs a contract directly with the hospice provider and the information is immediately sent to the State. The State changes the person's MEDS record to restricted so that the card states “Primary diagnosis care limited to hospice svs.” The special card covers additional hospice related services, while the patient is foregoing aggressive medical treatment.

Other Reasons

It must always be presumed that property transferred without adequate consideration was for the purpose of establishing eligibility for MC. The evidences or situations (e.g., sequence of events) must be sufficient and convincing enough to prove that the above assumption is not true. If the client can satisfactorily show that the nonexempt resources were transferred exclusively for a purpose other than to qualify for MC, there is no ineligibility for LTC services.

Reviewing the Look-Back Period

If a client indicates on his/her application that they did transfer one or more properties in the look-back period, the EW must consider the following to determine if it was a Disqualifying or Non-Disqualifying transfer:

Situation	If. . .	Then the transfer was. . .	Verification Required
Non-Exempt Property	The property was sold at Fair Market Value,	Non-Disqualifying.	Value of property at time of sale AND, Amount property sold for.
	The property was sold below Fair Market Value,	Disqualifying.	Value of property at time of sale, AND Amount property sold for.
	The property was gifted,	Disqualifying.	Client statement
Undue Hardship,	The client was incompetent at the time of transfer,	Non-Disqualifying.	Physician statement
	The client was competent but influenced by someone not taking action in the client’s best interest,	Non-Disqualifying.	Client statement
	All of the following conditions exist: The client is being threatened with eviction from LTC facility, Eviction would increase his/her medical problems or decrease physical health, The person who received the property no longer has it and cannot get it back,	Non-Disqualifying.	Eviction notice, Physician statement, AND Statement from the individual who received the transferred property stating they no longer have possession of the property and cannot obtain it.

If it was a non-disqualifying transfer, no further action is required. Document the reason(s) the transfer was non-disqualifying in the Journal page.

If it was a disqualifying transfer, the EW must determine if there is a potential Period of Ineligibility.

Periods of Ineligibility

General Rules

• A Period of Ineligibility (POI) for LTC services begins in the month in which the disqualifying property was transferred.
• POIs only apply to nursing facility level of care. The client will receive a restricted BIC which covers other types of medical services.
• A POI cannot exceed 30 months.
• A POI does not start and stop when an individual goes in and out of a nursing home.
• The POI stops if the property is transferred back.
• The POI can be reduced if a portion of the property is transferred back.

Reminder: Individuals must be reviewed for undue hardship before imposing a period of ineligibility. 

Average Private Pay Rate

When calculating a potential POI, the statewide Average Private Pay Rate used should be the amount that was in effect at the date of application or date of institutionalization (whichever is most recent).

The APPR amount changes annually; however, POIs are NOT recalculated when the APPR changes.

Consecutive Transfers

Each transfer is treated separately beginning with the month of transfer unless all of the following matches for every transfer:

• Date of transfer
• Recipient of the property
• Account number/Source

If one or more of the above is different, then they are considered separate transfers.

Periods of ineligibility may run concurrently, reducing the total number of months of ineligibility for nursing home level of care.

ExampleExample

Related Topics

Long Term Care (LTC)

Property Determinations for LTC Individuals