Medi-Cal FAQ: What Is The Look Back Formula Used By Medi-Cal?

Medi-Cal FAQ: What Is The Look Back Formula Used By Medi-Cal?

Hi there, Bridget Mackay, I’m an attorney in Petaluma, California, and I practice in estate planning and elder law. I’m doing a series of frequently asked questions about long-term Medi-Cal. You can also find these questions on my website at

In my last question, I dealt with the look-back period. And in question number four, the question is, “Which look-back formula will Medi-Cal use to determine if my family qualifies for benefits?” So, I used a previous example. I’m going to use our previous example from three which is, “Granny transfers $100,000 CD four months before applying for her long-term care Medi-Cal.

The formula Medi-Cal will use to determine if in her look-back, if she’s qualified to apply now, even though her asset level is down to $2,000 is this, Medi-Cal will divide the $100,000 gift by what they call the average private pay rate. The average private pay rate changes, but it basically is the average amount of the monthly cost to stay in a nursing home in California, and Medi-Cal updates this value usually on an annual basis. For example, in January 2016, this value was $8,189.

Here’s the calculation they would use for Granny’s $100,000 gift. They would take the $100,000, divide it by the $8,189 that was the average private pay rate, and that would equal 12 months in which Granny is barred from applying for long-term Medi-Cal benefits, or she would be denied.

Transfer assets very carefully and always do it with the advice of an experienced attorney.

By | 2017-08-11T09:38:02+00:00 Wednesday, October 26th, 2016|Medi-Cal, Video, Video Blogging|0 Comments

About the Author:

Bridget Mackay is a Petaluma estate planning attorney who has been practicing law since 1996. She is a member of the Sonoma County Bar Association, California State Bar Association Trust and Estates Section and on the Board of the Sonoma County Women in Law. She also sits on the Board of the Cinnabar Arts Corporation in Petaluma. Connect with Bridget on Google

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