The Connecticut Elder Law Blog

What is the Medicaid "Pick-Up Date"?

A lot of my Medicaid clients get confused over the date that Medicaid coverage kicks in (also known as the Medicaid "pick up date") once Medicaid eligibility has been determined by the State of Connecticut.

The short answer is that Medicaid can start as early as the first day of the month during which the Medicaid "spend-down" was completed, assuming that there are no issues with periods of ineligibility that have been triggered by gifting during the look-back period.  So, if an applicant spends his/her assets down below the Medicaid asset limit ($1,600) on November 20th, then Medicaid coverage can begin retroactively on November 1st.

Why would it start later than the first of the month?  Because if the spend-down included private payments to the nursing home which effectively paid for nursing home care past the first of the month, then the nursing home would not need Medicaid coverage until later in the month.  So, in the above example, let's assume that the Medicaid applicant made a partial payment to the nursing home as part of her spend-down and that payment covered her up until December 10th.  In that case, the Medicaid pick-up date would be December 11th so that the payment for care would be "seamless" for the nursing home.

A Helpful Exception to Gifting Penalties Under Medicaid

Most people with elderly family members are somewhat familiar with the general gifting rules under the Medicaid (Title 19) program.  Namely, that if you make gifts during the 5 years leading up to a Medicaid application then there is going to be an eligibility problem.

Many people don't realize that there are certain exceptions to that general rule.  For example, gifts to a spouse or a disabled child is not a problem.  Nor is gifting real estate to a sibling or a caregiver child under certain circumstances.

However, there is an even less known excpetion to the general rule which is specific to Connecticut.  Connecticut General Statutes sections  17b-261a(c) and 17b-2610(c) indicate that the State can waive the imposition of a penalty period due to gifting if (1) the applicant currently suffers from dementia and cannot explain the disqualifying gift, (2) the applicant suffered from dementia at the time of the gift, or (3) the applicant "was exploited into making" the gift due to the applicant's dementia at the time of the gift.  

Clearly, the biggest obstacle to using this exception is proving, to the State's satisfaction, that the applicant is/was suffering from dementia.  But if you have medical records to back it up then this exception to the gifting rule may be available.