PA Medicaid 5-Year Look-Back: What the County Assistance Office Checks
PA Medicaid 5-Year Look-Back: What the County Assistance Office Checks
Short answer: The Pennsylvania Medicaid 5-year look-back is a review of your financial records by the County Assistance Office. They check if you or your spouse transferred money or property for less than fair market value in the five years before you apply for the Community HealthChoices waiver.
- The County Assistance Office reviews five years of bank statements and tax returns.
- Both the applicant’s and their spouse’s asset transfers are checked.
- Gifts or selling property below market value can cause a penalty period where Medicaid will not pay for care.
- Paying for legitimate expenses at fair market value is not penalized, but you need receipts to prove it.
- You can appeal a penalty decision or request an undue hardship waiver.
What the look-back is
When you apply for the Community HealthChoices (CHC) waiver to receive home care, you must meet specific financial rules. The Pennsylvania Department of Human Services requires the County Assistance Office (CAO) to review your financial history. This review is known as the 5-year look-back.
The CAO looks back five years from the date you apply for the CHC waiver. They check to see if you transferred money, property, or other assets for less than fair market value during that time.
This rule applies to both the applicant and their spouse. Even if only one spouse needs home care services, the CAO reviews the financial transfers of both people. The goal is to ensure applicants did not simply give away their wealth to meet Medicaid eligibility requirements.
What the CAO reviews
The County Assistance Office will ask for detailed financial records when you submit your application. You must provide tax returns, bank statements, and other financial records covering the prior five years.
The CAO caseworker reads these documents to see exactly where your money went. They look for large withdrawals, closed accounts, or property title transfers. If they see a transfer they do not understand, they may ask you to explain how the money was spent.
If the records don’t show how money was used, the CAO may ask you to explain. Organized records make this part of applying for PA Medicaid for home care.
What counts as a transfer for less than fair market value
A transfer for less than fair market value happens when you give away an asset or sell it for significantly less than it is worth. The CAO considers these transfers as gifts.
According to the PHLP 2026 guide, a common example is selling a house to a grandchild for $1. Because the house is worth much more than $1, the CAO counts the difference between the $1 and the home’s actual market value as a penalized transfer.
Other examples include giving large cash gifts to family members, transferring a car title to a friend for free. However, paying your regular bills, buying groceries, or paying a contractor for home repairs at a fair market price is not a gift. As long as you receive goods or services equal to the money you spent, it is not a penalized transfer.
If you need home care services and have questions about starting care, call New Century Home Care at 215-974-0000 or fill out our contact form. Please choose “I am a client” and then “I need services.” Our office staff speaks English, Russian, and Ukrainian.
The penalty period
If the CAO determines you or your spouse made a transfer for less than fair market value, they will impose a penalty period. A penalty period is a specific length of time during which you are ineligible for CHC waiver services.
During this penalty period, Medicaid will not pay for your Personal Assistance Services or other waiver supports. The length of the penalty period depends directly on the total amount of money or asset value you transferred. The more you gave away, the longer the penalty period lasts.
You have the right to challenge a penalty. You can appeal the CAO’s decision by requesting a Department of Human Services Fair Hearing. You must submit your appeal in writing within 30 days of receiving the notice. The hearing takes place by phone or in person before an Administrative Law Judge. You can also request an undue hardship waiver of the penalty.
Practical steps
To protect yourself during the look-back period, keep all your receipts and financial statements. If you pay someone to provide care or do work around your house, document these payments in writing at the time they occur. Ensure you pay a reasonable market rate for the work performed.
If income rather than assets is the issue, see the options when income is over the limit.
Before moving any assets, selling property, or giving money to family members, talk to an elder law attorney. You can also contact the Pennsylvania Health Law Project (PHLP) Helpline at 1-800-274-3258. PHLP provides free legal help regarding Office of Long Term Living waivers.
Look-back vs estate recovery
Families often confuse the 5-year look-back with estate recovery. These are two completely different Pennsylvania Medicaid rules that happen at different times.
| Feature | 5-Year Look-Back | Estate Recovery |
|---|---|---|
| When it happens | Before approval, during the CAO application review. | After the Medicaid recipient passes away. |
| What it affects | Your eligibility for waiver services and potential penalty periods. | The estate of a recipient who was age 55 or older. |
| What is reviewed | Transfers of assets in the 5 years before applying. | The costs the state paid for nursing home care, waiver services, and related hospital/prescription costs. |
| Who handles it | The County Assistance Office (CAO). | The PA Department of Human Services Estate Recovery Program. |
For more details on what happens after a recipient passes away, read our guide on Medicaid estate recovery rules.
When you are approved for the CHC waiver and need a reliable caregiver in Philadelphia, Bucks, Chester, Delaware, or Montgomery county, contact New Century Home Care. Call 215-974-0000 or submit our online form, choosing “I am a client” and “I need services.”
Frequently asked questions
Does PA Medicaid check your bank account?
Yes. When you apply for the Community HealthChoices waiver, the County Assistance Office reviews your bank records and tax returns from the past five years. They check for large withdrawals or transfers to see if you gave away money for less than fair market value.
Can Medicaid take a jointly owned home?
For eligibility, the home the applicant lives in is excluded as a resource. However, after a recipient age 55 or older passes away, Pennsylvania can recover care costs from their estate. The state considers the estate value and whether a surviving spouse or dependent lives in the home.
Do you have to pay back Medicaid if you sell your house?
Selling a house can change financial eligibility, because the proceeds can become a countable resource. If you sell it for less than fair market value, it can trigger a penalty. Talk to an elder law attorney before selling property.
What is the maximum amount of assets you can have to qualify for Medicaid?
For the CHC waiver in 2026, an unmarried applicant can have up to $8,000 in resources. If you are married, the community spouse can keep at least $32,532, and the applicant keeps $8,000. Excluded resources include the home you live in and one motor vehicle.
Does the look-back apply to Medicare?
No. The 5-year look-back period is a Medicaid rule enforced by the County Assistance Office. Medicare eligibility does not use the look-back.
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