Long Term Care (LTC): UpdatedLook-Back Period for All Assets for LTC

The requirement for the 60 month look back is part of the Deficit Reduction Act of 2005. The 60 month look back is defined in Section 1917(c) of the Social Security Act.

The look back on all assets is 60 months before the first day the individual is both “institutionalized” and has applied for medical assistance.

The 60 month look back period begins from the date of application for all LTC waiver programs; including ADvantage, DDS HCBW services, Living Choice, Medically Fragile, PACE, and ADvantage Assisted Living services.

A full 60 months (5-year) look back on all assets is required for every LTC application unless the applicant is receiving SSI (Refer to the SSI Criteria State section below on how to handle applications receiving SSI. The full 60 month look back applies to both applicants who have never received services and to applicants who have or are receiving services. Documents needed include statements on all accounts, including detailed information on all deposits and withdrawals.

Exception for requesting bank statements:

  • If the AVS system completed the full 60 months look back on all accounts declared by the applicant and no months were flagged for possible transfers no bank statements will be required. Complete statements will be needed for any months flagged for possible transfers by AVS.

Refer to the following interpretations as they do NOT meet the defined look back criteria in Section 1917 (c) of the Social Security.

SSI-Criteria State

Oklahoma is an SSI-Criteria state. This means there is an Exception for completing a full or partial 60 months look back period for an SSI recipient depending on how long the individual has been receiving SSI. SSA has a 36 month look-back period for SSI applicants. DHS follows OHCA’s 60 month look back period policy for all LTC applicants – even for persons receiving SSI. The Exception guidelines and examples are shown below.

  • If the applicant has been receiving SSI for at least 2 years prior to making application for LTC benefits the SSI criteria would cover the full 60 months look back period.

Example

LTC application date is 4/8/2021. Applicant started receiving SSI on 3/1/2019. SSI 36 months look back period covered the time-period pf 3/1/2019 back to 3/1/2016.

  • LTC look back would start the first date the individual is both “institutionalized” and has applied for medical assistance. Date of admit to the NH was 3/27/2021 with a Nursing Home application date of 4/8/2021. Look back period would start 4/8/2021 and go back to 4/8/2016.
  • ADvantage waiver look back period would start the date of application 4/8/2021 and go back to 4/8/2016.
  • The SSI look back period covers the full 60 months LTC look back period for both application types no additional verification is needed unless something is questionable.
  • If the applicant has received SSI for less than 2 years prior to making application for LTC you will need to determine the SSI look back period and complete the look back on the additional months needed to complete the full 60 months look back.

Example 

LTC application date is 4/8/2021. Applicant started receiving SSI on 3/1/2020. SSI 36 months look back period covers the time-period of 3/1/2021 back to 3/1/2017.

  • LTC look back would start first day the individual is both “institutionalized” and has applied for medical assistance. Date of admit to the NH was 3/27/2021 with a Nursing Home application date of 4/8/2021. Look back period would start 4/8/2021 and go back to 4/8/2016.
  • ADvantage wavier look back period would start the date of application 4/8/2021 and go back to 4/8/2016.
  • The SSI look back period does not cover the full 60 months LTC look back period for both application types. AFS worker would need to verify the resources from 4/8/2016 through 3/1/2017 to complete the full 60 months look back period.

 

Finding SSI Information

The following are instructions on how to find information to determine when the applicant started receiving SSI and the SSI look back period:

  1. In IMS type py (space) and the Social Security Number and press enter.
  2. Tab down to the SDX line; type SDL; and press enter. This will show the dates SSI benefits were received.
  3. Find the first month SSI was received. This date will determine the SSI 36 month look back period.
  4. If this time-period covers the full 60 months LTC look back-period no additional verification will be needed.
  5. If this time-period does not cover the full 60 months LTC look back period the worker will need to request the verification for the months not covered by the SSI look back.

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