This series highlights the eligibility rules for Maine Medicaid (MaineCare) nursing home benefits and dispels certain myths the families that work with our office often hear.
The Truth: When an individual applies for MaineCare nursing home benefits, DHHS does a five-year look-back. Certain transfers are exempt from the transfer penalty, including transfers to spouses and to children with disabilities. For all other transfers made within the look-back period, a transfer penalty calculation is done. The “penalty” is a period of time that the individual is ineligible for those benefits. The value of all assets transferred is divided by the “transfer penalty divisor,” and the quotient is the number of months that the individual is ineligible for benefits. Currently, the divisor is $8,476. Example 1: A gift of $13,000 to a non-exempt individual creates a 1.5 month penalty ($13,000 ÷ $8,476 = 1.534). Example 2: A gift of real estate worth $120,000 to a non-exempt individual creates a little over a 14 month penalty ($120,000 ÷ $8,476 = 14.157). The penalty is prospective, and it does not start to run until after the MaineCare application is filed and the applicant is determined to be otherwise eligible for Medicaid benefits but for the penalty.