North Carolina Medicaid Look-Back Calculator

North Carolina's look-back and penalty divisor

North Carolina divides counted transfers by $11,904 per month (NC Medicaid Aged, Blind and Disabled Manual MA-2240, Transfer of Assets (revised 06/30/2026), effective January 1, 2025) and looks back 60 months.

• Any fraction of a day is dropped. (NC DHB ABD Medicaid Manual MA-2240 XI.B.1.a (rev. 06/30/2026, Change No. 09-26))
• If a person is discharged and readmitted after a sanction was imposed, the sanction continues until it ends. (NC DHB ABD Medicaid Manual MA-2240 XI.B.1.a (rev. 06/30/2026, Change No. 09-26))
• The manual revised in June 2026 still states the January 2025 rate. (NC DHB ABD Medicaid Manual MA-2240 XI.B.1.a (rev. 06/30/2026, Change No. 09-26))
• The fractional month is multiplied by 31 to get extra days, and any fraction of a day is dropped. (NC DHB ABD Medicaid Manual MA-2240 XI.B.1.a (rev. 06/30/2026, Change No. 09-26))
• The transfer rules apply to Community Alternatives Program waivers and PACE. (NC DHB ABD Medicaid Manual MA-2240 XI.B.1.a (rev. 06/30/2026, Change No. 09-26))

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.