South Dakota Medicaid Look-Back Calculator

South Dakota's look-back and penalty divisor

South Dakota has no published statewide divisor in our data. South Dakota divides by the statewide monthly average private-pay long-term care cost for the current state fiscal year, but the figure was not found on a DSS page. Enter the figure your caseworker or the facility gives you to see an estimate.

• Under the rule, more than one transfer produces consecutive periods of ineligibility. (ARSD 67:46:05:09.02)
• South Dakota's Medicaid state plan adds together transfers made in more than one month during the look-back period and figures a single penalty period, which differs from the rule's consecutive periods. (ARSD 67:46:05:09)
• A partial month of ineligibility is imposed, with the remainder rounded up to a whole day. (ARSD 67:46:05:09)
• The penalty start date is tied to eligibility for nursing facility or home and community-based waiver services. (ARSD 67:46:05:09.02)

Less certain: The current South Dakota divisor was not found in an official source, and the state rule and state plan differ on how multiple transfers combine.

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.