What is the Medicaid look-back period in North Carolina?

When the look-back applies

MA-2240 (revised June 30, 2026) applies transfer rules when you request or receive Medicaid for:

• Nursing facility care, an intermediate care facility for people with intellectual disabilities, or nursing-facility-level care in a swing bed or hospital bed.
• Home and community-based services through a CAP waiver, such as CAP/DA, or PACE.

It does not apply to regular Medicaid for doctor and hospital care at home, to Medicare Savings Programs, or when a spouse who lives at home (the community spouse) transfers an asset after you are approved.

How the 60 months are counted

• Starting point: the earliest date you are both institutionalized (or request CAP or PACE) and have applied for Medicaid.
• Look-back date: 60 months before the starting point. Once set, it never changes.
• Current Medicaid members: if you already have Medicaid and request CAP, the look-back date is based on the date you are placed on the CAP waiting list.

The county reviews assets you or your spouse owned during the period, including your home, other real estate, life estates, vehicles and bank accounts. It doesn't delay approving long-term care while it finishes the review.

Transfers that are allowed

• Transfers for fair value (money, goods or services worth at least the asset's equity).
• Anything transferred to your spouse, or to a blind or disabled child of any age.
• Your home transferred to a child under 21; a sibling who co-owns it and lived there at least a year before you entered a nursing home or requested CAP or PACE; or an adult child who lived there and cared for you for at least two years, which kept you at home.
• Transfers to a qualifying special needs trust, and money used for an irrevocable burial contract.

How a sanction works

1. The county totals the uncompensated value. All non-allowable transfers in the look-back period are treated as one transfer.
2. It divides by the private nursing home rate. MA-2240 sets an average monthly private nursing facility rate for North Carolina; the result is the sanction length in months and days.
3. You get notice. For people already receiving long-term care Medicaid, the sanction starts the first of the month after timely notice. You can rebut the finding or ask for an undue hardship waiver (MA-2245).
4. Other Medicaid continues. During a sanction, Medicaid still covers other services, and Medicare keeps paying for what it covers.

Talk with an elder law attorney before giving away property. More in NC Medicaid and Medicare. To review Medicare coverage, you can request a call from a licensed insurance agent.

Related questions

Sources

• NCDHHS — MA-2240, Transfer of Assets (revised 06/30/2026, change no. 09-26)
• NCDHHS — MA-2245, Undue Hardship Waiver for Transfer of Assets
• NCDHHS — MA-2230, Financial Resources
• U.S. Code — 42 U.S.C. 1396p(c), transfers of assets

More questions in this guide

• Are people with Medicare and Medicaid in NC Medicaid managed care?
• Can I have NC Medicaid and Medicare at the same time?
• Did NC Medicaid expansion change anything for people on Medicare?
• Does NC Medicaid pay for nursing home care?
• Does NC Medicaid take your house after you die?
• Medicare vs. Medicaid in North Carolina
• What is a dual eligible special needs plan in North Carolina?
• What is Special Assistance in North Carolina?
• What is the CAP/DA waiver in North Carolina?

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