Illinois Medicaid Look-Back Calculator

Illinois's look-back and penalty divisor

Illinois has no published statewide divisor in our data. Illinois divides by the private rate of the nursing home where the person lives, so there is no single statewide figure. Enter the figure your caseworker or the facility gives you to see an estimate.

• For supportive living and Department on Aging waiver cases, the private rate comes from the HFS Bureau of Long Term Care. (IDHS PM 07-02-20-d)
• The manual rounds the months up to two decimals, converts the fraction to days at 30 days a month, and charges any leftover part of a day as a dollar amount. (IDHS PM 07-02-20-d)
• There is no maximum penalty period. (IDHS PM 07-02-20-d)
• The penalty is stated in months, days and part of a day, and is not rounded down. (89 Ill. Adm. Code 120.388(j))
• Long-term care services under the rule include home and community-based waiver services. (89 Ill. Adm. Code 120.388(j))

How the look-back and the penalty work

When someone applies for Medicaid to pay for nursing-home care, the state looks back at gifts and transfers made for less than fair value. Federal law sets the look-back at 60 months before the application for transfers made since February 8, 2006, and California runs its own 30-month rule.

Every counted transfer in the window is added together and divided by the state's penalty divisor, the average monthly cost of private-pay nursing-facility care that the state publishes. The result is the number of months Medicaid will not pay for long-term care. Federal law says a state may not round a partial month down, and states handle the leftover fraction in different ways: as part of a month, as whole days, or as a one-time dollar charge. California, which runs its own rules, does not impose a partial month.

The penalty does not start on the date of the gift. It starts only when the person has applied, would otherwise be eligible, and is receiving long-term care, which is why a gift made years earlier can still delay coverage at the worst moment. California is the exception: under DHCS guidance a Medi-Cal period of ineligibility runs from the month of the transfer.

Transfers federal law does not penalize

Some transfers are exempt under 42 U.S.C. 1396p(c)(2): anything to a spouse or for the spouse's sole benefit; transfers to a blind or disabled child or a trust solely for that child's benefit; a trust solely for a disabled person under 65; and the home, when it goes to a spouse, a child under 21, a blind or disabled child, a sibling with an equity interest who lived there for a year, or a child who lived there for two years and provided care that kept the parent at home.

A penalty can also be avoided if the state accepts that the transfer was for fair value or made only for a reason other than qualifying for Medicaid, if all transferred assets are returned, or if the state grants an undue hardship waiver.