NCB is not a law firm or Medicaid planning advisor. This guide is educational information only. Medicaid rules are complex and change frequently. Before making any decisions about selling a home or transferring assets, consult a licensed New York elder law attorney and a certified Medicaid planner. Errors in Medicaid applications can result in months of ineligibility. Free elder law referrals in WNY: Bar Association of Erie County — (716) 852-8687.
The 5-Year
Medicaid Lookback
in New York
What it covers. How it works. What happens when the house gets sold. And what WNY families typically do when a parent needs nursing home care and the house is still in their name.
What Is the 5-Year
Medicaid Lookback?
When someone applies for Medicaid to cover nursing home care in New York, the state reviews every financial transaction from the previous 60 months — five years. This review is called the lookback period.
The state is looking for one specific thing: assets transferred for less than fair market value. Gifts to grandchildren. A house signed over to a child for $1. Money moved into a relative’s account. The state treats these as attempts to impoverish artificially in order to qualify for a program designed for people with limited means.
What triggers a penalty: any transfer of assets for less than fair market value during the 60-month window before the Medicaid application date. The penalty is a period of ineligibility — months during which Medicaid will not pay for nursing home care, regardless of whether the applicant otherwise qualifies.
What does not trigger a penalty: selling the home at fair market value. The proceeds become countable assets — which affects eligibility — but the sale itself is not a disqualifying transfer. This distinction matters enormously for WNY families deciding what to do with the house.
Two different Medicaid programs — two different rules.
Nursing Home Medicaid (institutional care): 60-month lookback, strictly enforced.
Community Medicaid (home care, adult day programs, assisted living services): currently no lookback period as of 2026. New York proposed a 30-month Community Medicaid lookback in 2020, has delayed implementation repeatedly, and as of early 2026 it has not taken effect. This is subject to change — confirm current status with an elder law attorney.
The lookback starts at application date — not admission date. A transfer made 4 years and 11 months before the Medicaid application is still inside the lookback window. Families who moved assets assuming a nursing home admission date was the starting point sometimes discover a penalty they didn’t anticipate.
What Happens to the House
Under the Lookback
The family home is usually the most significant asset involved, and it has special treatment under New York Medicaid rules that most families don’t know about.
The home is generally an exempt asset for Medicaid eligibility purposes — meaning it does not count toward the $33,038 asset limit — as long as the applicant intends to return home. This exemption applies even if the applicant is in a nursing home, provided an Intent to Return Home letter is included in the application.
However, the exemption has a limit: the applicant’s equity interest in the home must be below $1,130,000 in New York in 2026. Above that threshold, the home becomes a countable asset. Most Buffalo-area homes are far below this limit.
If there is a spouse still living in the home, the home is exempt without any equity limit requirement, and Medicaid cannot force a sale while the community spouse lives there.
New York has a Medicaid Estate Recovery Program (MERP). After a Medicaid recipient passes away, the state files a claim against the estate to recover costs paid for nursing home care. In New York, MERP can only recover through the probate estate — assets that must pass through a will or intestacy. Assets held in trust, jointly titled with right of survivorship, or with named beneficiaries generally pass outside of probate and are not subject to MERP recovery.
This is why the sequence and structure of how the home is titled matters significantly. A home solely in the deceased Medicaid recipient’s name at death is subject to MERP recovery. A home properly placed in an irrevocable Medicaid Asset Protection Trust (MAPT) more than five years before the Medicaid application is generally protected.
How the Penalty Period
Is Calculated
When Medicaid finds a disqualifying transfer during the lookback window, they don’t deny benefits permanently. They impose a penalty period — a number of months during which Medicaid will not pay, even if the applicant is otherwise eligible. The family must pay privately during that window.
During those 10 months, the family pays the nursing home privately — at actual nursing home rates, which in WNY often exceed the regional penalty divisor used in the calculation. A $15,000 monthly divisor against a $20,000/month facility means the family is absorbing more than the math initially suggests.
The penalty period does not begin until the applicant is in a nursing home and would otherwise be eligible. A disqualifying transfer made today does not start the clock immediately. The clock starts when the person is institutionalized and applies. This means a family that transferred assets and then needs nursing home care within five years faces a penalty that starts when they are most vulnerable — when care has already begun and bills are accumulating.
The regional penalty divisor varies by area of New York. WNY — Erie and Niagara County — falls under upstate regional rates that differ from downstate (NYC metro) rates. Confirm the current WNY divisor with a local elder law attorney before making any calculations.
Transfers That Are
Exempt from Penalty
Not every transfer triggers a penalty. New York law recognizes specific exempt transfers — situations where assets can move without starting a penalty period, even within the 60-month lookback window.
| Transfer To | Exemption | Conditions |
|---|---|---|
| Spouse | Fully Exempt | Transfers between spouses do not trigger a penalty. Note: spousal refusal strategies exist but can create future recovery exposure. |
| Disabled child | Fully Exempt | Child who is blind or permanently disabled under Social Security criteria. |
| Caregiver Child | Home Transfer Exempt | Adult child who lived in the parent’s home for at least 2 years immediately before institutionalization AND provided care that delayed the parent’s need for nursing home level care. Documentation required. |
| Sibling with equity interest | Home Transfer Exempt | Sibling who already has an equity interest in the home and has lived there for at least 1 year before the parent’s institutionalization. |
| Irrevocable Medicaid Trust (MAPT) | Exempt after 5 years | Assets transferred into a properly structured irrevocable trust are protected once 5 years pass from the transfer date. Transfer itself starts the lookback clock. |
| Fair market value sale | Not a Violation | Selling the home at fair market value is not a disqualifying transfer. Proceeds become countable assets and affect eligibility calculation, but the sale itself does not create a penalty period. |
This table is a simplified summary. Eligibility for each exemption depends on specific factual circumstances. Consult a NY elder law attorney before relying on any exemption.
Selling the House
During or After Medicaid
Selling the home at fair market value is not a Medicaid violation. The sale does not trigger a penalty period. What changes is the status of the proceeds: cash from the sale becomes a countable asset and counts toward the $33,038 limit.
For a single applicant whose only significant asset was the home, selling it and receiving $180,000 in proceeds means they now have $180,000 in countable assets — well above the limit. They would need to spend down to $33,038 before Medicaid eligibility resumes. The spend-down must be on legitimate expenses: nursing home bills, medical expenses, legal fees.
For WNY families, this often looks like: selling the house at fair market value, using proceeds to pay privately for nursing home care during the spend-down period, and applying for Medicaid once assets are within limits. An elder law attorney can structure this process efficiently.
NCB purchases Buffalo homes as-is — any condition, at fair market value for the property’s condition. For families who need to move quickly — a nursing home admission date, an estate timeline, a house that needs significant work — a direct cash sale can close in 7–14 days. No repairs. No showings. The sale qualifies as fair market value for Medicaid purposes. See the full guide for families in this situation →
Selling the home to a family member at a reduced price — $50,000 for a house worth $150,000, for example — is treated as a partial gift. The $100,000 difference is a disqualifying transfer subject to the penalty calculation. This is one of the most common Medicaid mistakes WNY families make, often with the best intentions.
A vacant house creates ongoing costs — taxes, insurance, utilities, maintenance. For single applicants with no one to maintain the property, keeping the house creates expense without benefit. If the intent-to-return exemption lapses or is not filed, the home can become a countable asset.
Many WNY families in this situation choose to sell the home through an as-is sale rather than manage a vacant property through a traditional listing. Coordinating repairs, showings, and a 60–90 day traditional sale timeline while managing a nursing home admission is more than most families can handle.
New York’s MERP files claims through the probate estate only. If the home passes through probate, MERP will file a claim for reimbursement of Medicaid costs paid. Planning options that avoid probate — properly structured irrevocable trusts, joint ownership with right of survivorship, beneficiary deeds — can protect the home from MERP in appropriate circumstances. This planning must be done in advance, ideally more than five years before the Medicaid application.
5-Year Medicaid Lookback NY — FAQ
What is the 5-year Medicaid lookback in New York?
New York’s 5-year Medicaid lookback is a 60-month review period that begins on the date a person applies for Medicaid to cover nursing home care. The state reviews all financial transactions during those 60 months looking for assets transferred for less than fair market value — gifts, below-value sales, certain trust transfers. Disqualifying transfers result in a penalty period during which Medicaid will not pay for care. The lookback applies to nursing home (institutional) Medicaid. As of 2026, Community Medicaid (home care) in New York does not have a lookback period, though a 30-month lookback has been proposed and repeatedly delayed.
Does selling the house trigger the Medicaid lookback in NY?
Selling the house at fair market value does not trigger the lookback or create a penalty period. The sale is not a disqualifying transfer. What changes is the nature of the proceeds: cash from the sale becomes a countable asset and is added to the applicant’s asset total. If proceeds push the applicant above the $33,038 asset limit, they must spend down before Medicaid eligibility resumes. The spend-down must be on legitimate expenses — nursing home bills, medical expenses, home modifications, legal fees. A cash sale to NCB at fair market value qualifies the same as a traditional sale.
Can I sell my parent’s house while they are in a nursing home?
Yes — but the consequences depend on your parent’s Medicaid status. If your parent is not yet on Medicaid, selling at fair market value simply converts the home into cash, which is a countable asset. If your parent is already on Medicaid, selling the home may affect ongoing eligibility because the proceeds become countable. The home is generally exempt from Medicaid’s asset limit while the parent is living and intends to return — but once sold, the proceeds are not exempt. Before selling, consult an elder law attorney about your parent’s specific situation. See our guide for families in this situation →
What happens if my parent gave away their house before going to a nursing home?
If the home was transferred for less than fair market value within 60 months of the Medicaid application, it triggers a penalty period. The penalty is calculated by dividing the transfer value by the regional penalty divisor (approximately $15,000/month in WNY). For example, a home worth $150,000 transferred to a child for $1 would generate a 10-month penalty. During those 10 months, Medicaid will not pay for nursing home care. The family must pay privately. The penalty period starts when the applicant is institutionalized and otherwise eligible — not when the transfer happened.
Is there a way to transfer the house without triggering the lookback?
Yes — specific exempt transfers exist. A home can be transferred without penalty to: a spouse; a disabled child; an adult child who lived in the home for at least 2 years immediately before institutionalization and provided care that delayed the need for nursing home level care (Caregiver Child Exemption); or a sibling with an equity interest who lived in the home for at least 1 year before institutionalization. A home transferred into a properly structured irrevocable Medicaid Asset Protection Trust (MAPT) is protected after 5 years pass. All of these exemptions have specific factual requirements — they require attorney guidance to structure correctly.
What is the Caregiver Child Exemption in New York?
The Caregiver Child Exemption allows a parent to transfer the home to an adult child without triggering the Medicaid lookback penalty, if that child: (1) lived in the parent’s home for at least 2 years immediately before the parent entered a nursing home, and (2) provided care during that period that delayed the parent’s need for institutionalization. Documentation matters — medical records, caregiver logs, and physician statements help establish the exemption. The child must have actually provided hands-on care, not simply lived in the home.
What is MERP and will it take my parent’s house?
MERP stands for Medicaid Estate Recovery Program. After a Medicaid recipient passes away, New York files a claim against the probate estate to recover costs paid for nursing home care. In New York, MERP can only recover through the probate estate. If the home passes through probate in the deceased Medicaid recipient’s name, MERP will file a claim. If the home was properly placed in an irrevocable trust, held jointly with right of survivorship, or otherwise structured to pass outside probate, MERP generally cannot reach it. MERP recovery is not immediate — it is a claim against the estate after death, not a forced sale during the parent’s lifetime.
Does a cash buyer sale count as fair market value for Medicaid?
Yes — provided the sale is conducted at fair market value for the property’s actual condition. An as-is sale to a cash buyer like NCB is a legitimate fair market value transaction. The price reflects the home’s condition — needed repairs, carrying costs, as-is sale discount — but the transaction itself is a market-rate exchange, not a gift or below-value transfer. For families who need to sell quickly during a nursing home admission — or who have a property in poor condition — an as-is cash sale is often the most practical path. The proceeds then enter the asset calculation and spend-down process in the same way a traditional sale would.
Real WNY Families — Real Situations
What Families Said
After the Call From the Nursing Home
Every situation is different. Every house has a story. These are a few of the families NCB has worked with across Western New York.
“My dad has dementia. He was in memory care and couldn’t go back to the house on Niagara Falls Boulevard. We live in North Carolina. I couldn’t coordinate repairs, showings, or cleanouts from 700 miles away. NCB walked through, made us a written offer the next day, and we closed in 10 days. I never had to fly back to Buffalo.”
“My aunt went into assisted living in Cheektowaga and her house on Abbott Road sat empty for eight months while we figured out what to do. By the time we called NCB, we’d already paid two winters of heating bills on a vacant house. They bought it as-is — 40 years of her belongings still inside. We took what mattered and walked away.”
“My cousin has power of attorney for her mother’s estate. The house in Lovejoy needed a new roof, had old knob-and-tube wiring, and was full of furniture nobody wanted to deal with. Three agents told us it wasn’t listable without $30,000 in work. NCB bought it the way it was. My cousin was done in two weeks.”
“We were trying to figure out the Medicaid spend-down while managing my mother’s care in a facility in Cheektowaga. The elder law attorney told us we needed to sell the house and document everything. NCB understood the situation. They worked around our attorney’s timeline and made sure the closing was clean. It was the one part of the process that wasn’t a fight.”
“Both my parents needed care at the same time. The house in Kenmore was in both their names. We had siblings who disagreed about what to do. NCB was patient with us while we got everyone aligned. When we were ready, they moved fast. No judgment, no pressure. That meant more than I expected.”
“My father had been in the house in Depew since 1974. When he went into the nursing home, none of us could face clearing it out. Fifty years of his life was in that house. NCB said we could take whatever we wanted and leave the rest. We took his tools and his photo albums. Everything else stayed. I don’t know how we would have done it any other way.”
Need to Sell the House
During a Nursing Home Situation?
NCB buys Buffalo homes as-is — any condition, any situation. Cash offer in 24 hours. Closes in 7–14 days. The sale qualifies as fair market value for Medicaid purposes. No repairs, no showings, no listing delays.
Related Resources
NCB Serves All of Western New York
Nickel City Buyers, LLC — Buffalo’s Cash Home Buyer Since 2013 · 3842 Harlem Rd STE 400-339, Cheektowaga, NY 14215 · (716) 557-7005 · A+ BBB · 5.0 Google · 300+ homes · Erie & Niagara County · Medicaid Lookback New York · Sell House Nursing Home Buffalo NY · 5-Year Medicaid Lookback NY · Medicaid Asset Protection Trust WNY · MERP New York · Sell Parents House Buffalo · Buffalo, Cheektowaga, Amherst, Tonawanda, West Seneca, Lackawanna, Hamburg, Orchard Park, Lancaster, Depew, Kenmore, Williamsville, East Aurora, Niagara Falls, Lockport, North Tonawanda, Grand Island and all of WNY.