Vermont Medicaid Look-Back Calculator

Vermont's look-back and penalty divisor

Vermont has no published statewide divisor in our data. Vermont counts the penalty in days by dividing by the average daily private cost of nursing facility care, but the current figure was not found on an official page. Enter the figure your caseworker or the facility gives you to see an estimate.

• Transfers in different calendar months create penalty periods that run one after another, in the order made. (Vt. HBEE Rule 25.04 (01/15/2017, GCR 16-097))
• A penalty runs continuously from its first day even if the person stops receiving long-term care. (Vt. HBEE Rule 25.04 (01/15/2017, GCR 16-097))
• During the penalty Medicaid does not pay for the person's long-term care services and supports. (Vt. HBEE Rule 25.04 (01/15/2017, GCR 16-097))

Less certain: The current Vermont divisor was not found in an official source.

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.