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Medicaid Look-Back Review

A Medicaid look back review that reads five years of a client’s statements, explains each transfer and gap in plain words, and shows the penalty before filing.

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Walk the look-back from grid to signed memo ↓

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The problem

Thousands of statement pages, a spreadsheet of withdrawals and a receipt hunt

A client moves into a nursing home and the family arrives with a box. The paralegal reads five years of bank, brokerage and credit union statements, types each withdrawal into a spreadsheet, then chases the months that never came and the receipts behind each check.

The trouble lands late. A missing statement turns up when the caseworker asks about it. Money paid to a daughter who gave the care reads as a gift until someone finds the written agreement and the care log. And the attorney still cannot see which explanation would shorten the penalty, or by how much.

Built forElder law attorneysMedicaid paralegalsPractice leadersFirm administrators

The Problem Today

Medicaid looks back five years at each account, and each unexplained dollar becomes days the family pays for care.

63%: of nursing facility residents have Medicaid as their main payer published
60: months of each account read before a long-term care application published

Read and listed by hand today

Statements
Checks
Gaps
Requests

Missing months found lateA gap surfaces after the caseworker asks about it
Family care with no paperWithout the agreement, a daughter’s pay reads as a gift

The Solution

Five years on one gridEach account, each month: a cell per statement, the missing ones marked
Each transfer in plain wordsPaid for care, own accounts, a gift or unexplained, each with its page
The penalty, counted liveThe state’s divisor, and which explanation would shorten it most
One letter, one signed memoThe family is asked once; the attorney approves and signs

Built-in controls

Nothing reaches the family or the caseworker unapproved
Account numbers cut to their final four digits
Client files kept inside the firm’s workspace

What You Get

Firms file with each transfer explained or disclosed, and the family knows the penalty before the caseworker does.

3 hours: of paralegal reading per look-back, down from about 20 our estimate

One letter to the familyOnly the missing months and questions, each with why
Each month accounted forIn hand, or listed as missing, before filing
The penalty, known before filingCounted with the state’s divisor, beside what would shorten it

Inside the look-back

A Medicaid look back read month by month, each transfer explained, then signed

Statements read first, the attorney’s signature last, and one feature on each screen between.

01Five-year look-back grid
A look-back grid of every account and month, missing statements hatched
How it works
- One cell per account per month, five look-back years laid out November to October
- Each transfer over $1,000 sits in its month as a marker, colored by what it is
- The header counts 2,960 pages read, 233 of 240 statements in and 7 months missing
Medicaid planning paralegalSpots on day one the month nobody sent, so the gap is in hand before the caseworker finds it.
02Statements received and missing
A gap list that says what each missing month could hide
How it works
- Each account card shows statements in, pages read and transfers over $1,000
- Each missing month carries what it could hide, read from the statements on either side
- One checking gap hides 10 checks: the numbers jump from 4391 to 4402
Medicaid planning paralegalKnows why each missing statement matters, so the request to the family is specific and no gap is assumed empty.
03Transfer and gift register
A transfer and gift register in plain words, each line cited to its page
How it works
- All 23 transfers over $1,000 in one table, by month and date
- Each reads own accounts, paid fair value, paid for care, gift or unexplained
- Each source opens the statement page behind the line
Elder law attorneyReads five years of money movement in one table, with no spreadsheet of withdrawals to rebuild.
04Care agreement proposal
Family caregiver pay matched to a signed agreement and a log of hours
How it works
- Proposes the $24,000 check as paid for care under a written agreement
- Signed before any care, at $25 an hour against an agency rate of $31
- A care log for 960 hours, each paid after the care, never in advance
Elder law attorneyChecks in one view whether a caregiver’s pay holds up as payment for care, then approves it, or sends it back with a reason.
05Penalty counter
A live penalty counter that shows which explanation buys back a month
How it works
- Uncompensated transfers divided by the state’s daily divisor, in days and months
- After the care agreement is approved, $24,300 counts: 57.7 days, 1.9 months
- Ranks what would shorten it next, from receipts for the cash to a loan repaid
Elder law attorneyKnows the penalty the family faces before filing, and which open question is worth chasing first.
06Penalty calculator
What-if switches that price each explanation before anyone approves it
How it works
- The formula on screen: $24,300 ÷ $421.20 a day = 57.7 days
- A switch for each explanation the family might still give
- Receipts for the $9,500 cash would take 1.9 months to 1.2
Elder law attorneyCan tell the family what a receipt or a returned gift is worth in months of private-pay bills before asking for it.
07Letter to the family
One letter to the family that asks only for what is missing
How it works
- Drafted from the gap list and the transfers still open
- Each statement says where to get it, such as a reprint from the bank
- Each question says what is at stake: about 0.7 months for the cash receipts
- Goes out with a private upload link once the paralegal approves it
Medicaid planning paralegalAsks the family once, in words they can act on, instead of weeks of email asking for statements one by one.
08Application exhibits
An application exhibit pack in filing order, with what is still to come
How it works
- Tabs in the order the firm files them, with page counts: 3,032 pages in all
- The statements tab shows 233 of 240 months, with 7 requested
- The register and penalty estimate go in as their own tab
Medicaid planning paralegalHas the filing pack built straight from the reviewed file, with nothing left to print, put in order or bookmark.
09Look-back memo
A look-back memo cited line by line, signed by the attorney before filing
How it works
- Drafted from the register: own-account moves, fair-value payments, gifts and open questions
- Each line carries its citation, a statement page or an exhibit tab
- Before signing, a check panel shows what is open, such as 7 statements requested
Elder law attorneySigns a memo whose figures each trace to a page, eight days before filing, with both gifts disclosed and the open items listed.

What the gaps and transfers in one client file turned up

Ten unseen checks, a savings fall, a brokerage drop and caregiver pay, each settled before filing.

Ten checks nobody has seen

Check numbers jump from 4391 before the gap to 4402 after it. Any of those ten checks could be a gift, so the missing statement goes into the letter.

Savings that fell with no matching credit

The savings balance dropped $3,100 across three missing months, and nothing arrived in checking. Until those statements come in, nobody can say where it went.

A brokerage drop that is probably the market

$148,210 before the gap, $141,960 after it. The $6,250 drop is most likely the market, but only the two statements can show it.

A caregiver’s pay that looked like a gift

A $24,000 check and eight monthly transfers of $1,300 to the daughter who gave the care counted against her mother until the agent found the agreement and the log.

The penalty after each explanation, from 4.6 months down to 0.7

One client file, counted with the state’s daily divisor. Rows below the care agreement are what-ifs from 1.9 months.

What the file shows	Stops counting	Penalty, months
The agents’ first pass	Nothing yet: $58,700 counts	4.6
The care agreement, approved by the attorney	$34,400	1.9
Receipts for the counter withdrawal	$9,500	1.2
The grandson returns his tuition gift	$6,000	1.4
Fair value shown for the check to a payee	$4,800	1.5
A loan repaid, shown for the nephew’s payment	$1,500	1.8
All three unexplained transfers documented	$15,800	0.7

Around the file

Around the Medicaid look back file: reruns, uploads, proof and the audit log

Screens the paralegal and attorney keep open beside the grid.

Agent run re-reading 233 statements and 2,960 pages, checking 240 account-months and re-adding the penalty, above a missing savings month — **A full re-read, on demand**One click re-reads 233 statements, rechecks 240 account-months and re-adds the penalty.

Statement reader run over three family uploads of nine pages: a duplicate set aside, nothing new in the sixty months, seven months still missing — **New uploads, read on arrival**Three family uploads, 9 pages. A duplicate statement is set aside; the seven gaps stay open in the letter.

Register filtered to unexplained transfers, the $9,500 cash withdrawal from savings open beside its statement line and the question to the family — **The open lines, filtered**Filtered to 12 open lines. The $9,500 counter withdrawal stays unexplained until receipts show what the cash bought.

Register filtered to care and fair-value payments, the $8,450 roof check open with its statement line and the contract that explains it — **Paid at fair value, with proof**Six payments for care or fair value, $33,757 in all. The roof check matches a signed contract and paid invoice.

Care log source page opened from a citation: hours for each month of the year, 960 hours at $25.00 an hour and the tasks the daughter did — **The care log behind the check**A citation opens its source: monthly hours adding to 960 at $25.00, the $24,000.00 the check paid.

Audit trail of the look-back penalty period file: agent reads, the attorney’s approvals, the letter sent by the paralegal and the signed memo — **Who explained, who approved**Agent steps, approvals and messages with who did each: the gift approvals, the care agreement, the letter and the signature.

Who drafts

Agents that read, match and count while the attorney decides disclosure

What to ask the family and what to disclose stay with the paralegal and the attorney.

Statement reader

Reads statements and check images from any bank or brokerage, paper scans or downloads, and cites the page behind each line.

Never edits a figure

Gap finder

Builds the sixty-month grid per account and lists each missing month with what it could hide.

Never assumes a missing month was empty

Transfer flagger

Flags transfers, checks and cash withdrawals over the threshold, and matches moves between the client’s own accounts at both ends.

Never calls a transfer a gift: it asks

Explanation matcher

Matches each flag to an invoice, receipt, deed, care agreement or family answer, and proposes plain words with the source.

Never marks a transfer explained without a document or a person’s approval

Penalty estimator

Adds up the uncompensated value, divides by the state’s divisor and shows what would shorten the penalty.

Never advises the client
Never decides what to disclose

Memo and exhibit agent

Drafts the family letter, the look-back memo and the exhibit pack, with each figure cited.

Drafts only: nothing goes to the family or the caseworker

Gifts, gaps, caregiver pay and the divisor: the questions behind a look-back

What is a Medicaid look back review?

A Medicaid look back review reads the client’s statements for the whole look-back period, lists each transfer and each missing month, and explains them before the application is filed. This solution puts the months on one grid, says what each transfer was in plain words with its page, and keeps a running penalty estimate that the attorney signs off.

What does Medicaid look for in bank statements?

Money that left for less than fair value: gifts, payments to relatives with no paper behind them, and cash nobody can trace. A missing statement matters too, because nobody can show that no money left that month. The solution flags each transfer over the firm’s threshold and lists each gap with what it could hide.

How does it treat payments to a family caregiver?

It looks for a written care agreement signed before the care began, a rate at or below the local agency rate, a care log for the hours paid, and payment after the care rather than in advance. When those hold, it proposes the payments as paid for care, and only an attorney can approve that.

What happens to a cash withdrawal nobody can explain?

It stays unexplained and keeps counting toward the penalty period. The letter to the family asks for receipts or a note of what the cash paid for, and the counter shows how much shorter the penalty would be if they arrive.

Does it use our state’s penalty divisor?

Yes. The firm administrator sets the state, the daily divisor and the date it applies from. The divisor in force when the decision is made is the one used, and the settings say whether the penalty is counted in days or months.

Who approves what before the application goes in?

Messages to the family wait for the paralegal’s approval. The attorney approves each explanation that changes the penalty and signs the look-back memo. Agents draft and propose; they do not contact the family or the caseworker, and they do not decide what to disclose.

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