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TITLE 16 HEALTH AND SAFETY DELAWARE ADMINISTRATIVE CODE 31 20350.1.10 Average Monthly Cost Average monthly cost is the average cost to a private patient for a month of nursing facility services in Delaware at the time of application. The monthly rate is determined based on 365 days divided by 12 months or 30.42 days per month. This is not the average Medicaid per diem rate. 20350.2 Look-Back Date and Look-Back Period 20350.2.1 Look-Back Date 20350.2.2 Look-Back Period 20350.2.3 Look-Back Period for Transfers of Assets Involving Trusts 20350.2.1 Look-Back Date The look-back date is the earliest date on which a penalty for transferring assets for less than fair market value can be assessed. Penalties can be assessed for transfers which take place on or after the look-back date. Penalties cannot be assessed for transfers which take place prior to the look-back date. See Section 20350.2.3 Look- back period for transfer of assets involving trusts For long term care applications filed on or after 2/8/06 and assets transferred on or after 2/8/06, the look-back date is 60 months prior to the baseline date. The baseline date is the first date as of which the individual was: institutionalized; AND has applied for medical assistance under the state plan. When an individual applies for Medicaid more than once (for example, he or she applies for Medicaid, is denied eligibility because of excess resources, and applies again 6 months later), the look-back date is 36 months prior to the baseline date. The baseline date is the first date (first time) the individual has applied for long term care Medicaid. Each individual has only one look-back date, regardless of the number of periods of institutionalization, applications for Medicaid, periods of eligibility, or transfers of assets. All transfers of assets after that date fall within the look-back period. 10 DE Reg. 1613 (04/01/07) 20350.2.2 Look-Back Period The look-back period is the period that begins with the look-back date and ends with the baseline date. It is the period of time prior to the baseline date (see above) during which a previous transfer of assets for less than fair market value can be penalized. It is important to remember that transfers which occur after the baseline date are also subject to penalty if they are made for less than fair market value. Effective 2/8/06, the date of the Deficit Reduction Act of 2005 (DRA) enactment, the look-back period was extended from 36 months to 60 months. Any transfers that occur on or after 2/8/06 will be subject to a 60 month look-back period. 10 DE Reg. 1613 (04/01/07) 20350.2.3 Look-Back Period for Transfers of Assets Involving Trusts When an individual establishes a revocable trust and a portion is disbursed to someone else and not for the benefit of the grantor, that portion is treated as a transfer of assets. For a revocable trust, the transfer is considered to take place on the date upon which the payment to someone other than the grantor was made. When an individual establishes an irrevocable trust in which all or a portion of the trust cannot be disbursed to or on behalf of the individual, that portion (the portion that is unavailable) is treated as a transfer of assets. For an irrevocable trust, the transfer is considered to have been made as of the date the trust was established or, if later, the date upon which payment to the grantor was foreclosed. Whenever a portion of a trust is treated as a transfer (as described above), the look-back period is 60 months. When a trust is irrevocable but some or all of the trust can be disbursed to or for the benefit of the individual (the portion that could be made available to the individual), the look-back period applying to disbursements made from this portion to another person is 60 months. Effective 2/8/06, the date of the DRA enactment, all trusts will be subject to a 60 month look- back period. When an individual places assets into an irrevocable trust and can still benefit from those assets, the amount transferred is equal to any of those assets which are paid out for a purpose other than to or for the benefit of the individual. When an individual places assets in an irrevocable trust and can no longer benefit from some or all of those assets, that unavailable portion is considered as a transfer. The value of these assets is not reduced by any payments from the trust which may be made from these unavailable assets as a later date. 10 DE Reg. 1613 (04/01/07)