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To determine the lookback date for individuals requesting institutional services the local agency must establish the starting point.
1. The starting point is the earliest date that both conditions in a. and b. are met: a. The a/b is institutionalized (See XV. Glossary for a definition of institutionalized) or requests CAP or PACE, and b. Applies for Medicaid. 2. A training guide located on the DHB Medicaid Training Resources, A Guide to Establishing Starting Point/Lookback, provides an overview and guide to determine the starting point and lookback dates. 3. Scenarios
a. If an individual is a current Medicaid applicant or beneficiary in PLA when they are institutionalized, use the day they entered the institution as the starting point to establish the lookback date.
b. If the a/b is currently institutionalized as private pay and has never applied for Medicaid before, use the date of the current application as the starting point to establish the lookback date.
c. For individuals applying for the CAP, or PACE programs, the starting point is the date the a/b applies for Medicaid and requests CAP or PACE.
d. If the a/b is an ongoing Medicaid beneficiary when they requested CAP, the lookback date is based on the date the a/b is placed on the CAP waiting list. If questionable, verify this date with the CAP case manager.
C. Establish the Lookback Date for Transfers
1. The look back date is 5 years (60 months) from the starting point.
2. Review all assets owned by the a/b or their spouse within the lookback period to determine if any transfers have occurred.
3. In situations involving an Institutionalized Spouse (ISP) and Community Spouse (CUSP), where the CUSP later becomes institutionalized, determine the starting point and lookback date for the CUSP independently from the ISP.
D. The Lookback Date Never Changes
1. Once the lookback date is correctly established, it never changes. This is true regardless of any future re-applications or additional periods of institutionalization.
a. Evaluate all transfers beginning on or after the lookback date.
b. Do not consider transfers made prior to this date.