If we have a joint bank account with mom can we remove the money before she goes in a nursing home and avoid the 5 year look back?

You need to be careful and be able to prove your ownership of whatever you take. The state will view the account as wholly her's unless you can do that.

When the Medicaid application is done, they or their DPOA sign off on the state's ability to go into any & all financial data and personal information for up to 5 years. The look-back is 5 years but the federal guidelines allow for up to 10 years if fraud is suspected. Joint accounts are included in the look-back.

For my mom, lookback was 3 years and 6 months of financials. There was really 2 levels of vetting done for her:
-- Level 1 @ the NH: the 6 months prior to the date of entry into the NH was reviewed by the NH business office to determine if they would accept mom as a "Medicaid Pending" resident. If their review determined there might be a problem, then she could still get admitted but NOT as Medicaid Pending. That would mean placing a large sum of $$ upfront or signing a contract with the NH of your (the family's) responsibility to private pay the NH if Medicaid is declined. My mom was in IL & still has her home, so her bank statements clearly showed a pattern of spending to decrease her assets to the 2K limit for Texas. She was admitted
"Medicaid Pending" to NH with all her income less $ 60 paid to NH monthly.
-- Level 2 review by the state caseworker: had to provide for an accounting of each and every bank account or other financial closed for the 3 years prior to the 6 months already submitted. Years before I had mom condense banks down to 1 bank, so that helped as just had to visit 1 bank needed to do this. But it took a full morning with a bank officer as they had to go through everything and where it went, so it was CD # 123 expired 2/27/2009 for $ 5K & deposited into checking account # 456 on 2/28/2009; T bill # 987 closed and deposited into checking account # 456 on 10/1/07 sort of thing. This accounting was done on bank letterhead, 2 pages with bank officer signature and notary seal. This was sent to caseworker as a required part of the application. All my mom's stuff was closed down and funneled into a single checking account so it was pretty transparent where the $ went and how it was spent down. If there had been a cashier's check for a closed out CD or T bill, I'm sure we would have gotten an transfer penalty inquiry letter sent to us. But she didn't do that so no issues there. Financial Application took almost 6 month to be approved.

Personally I think the state is looking for patterns of spending to determine if the application undergoes a deeper level of scrutiny. So if 3 years ago, they had 50K now have just 2K, that totally makes sense if they have been paying for IL, a car, a home, etc for the past 3 years. If their income is just $ 1,500, then they are short 14 - 20K every year and could easily have spent down 50K.

But if they had 50K in savings 3 years ago and have been living with family for the past 3 years and have $ 1,500 in income monthly and now have just 2K, that doesn't make sense. Where did all the $$ go? The pattern of spending doesn't exist for where the $$ could have legitimately & simply gone to. They should have lots, lots more $$ so the state can do a transfer penalty inquiry. Understand?

The transfer penalty is totally sticky and if it's about financials and house transfer, then imho you need an attorney to work it out for you. I dealt with a transfer penalty on my mom's car. She gifted it not quite 5 years back. There is a whole set formula on how transfer penalty's are determined. Each state is different as it is based on your state Medicaid reimbursement rate for the period of time in which the transfer happened. Confused? yeah it's totally loco to figure out. For house or auto's, all the ownership is done by the local tax assessor and then dovetailed to the state's database. So eventually the transfer will show up. My mom's auto transfer showed up in month 4 of her Medicaid pending application. Transfer penalty based on cars Blue Book value - the model and style was wrong, so got it lowered due to that. & I was able to show cancelled checks to the mechanic to show that the car wasn't even worth that due to all the repairs. So got the value down to where it basically was within her asset limit. I got it all done within a week as I had the checks and knew mechanic (been there forever) to sweet talk his office into doing a letter. But if I hadn't, mom's application would probably have been declined till the transfer penalty was private paid by us. For a car, the transfer penalty is kinda DIY to clear and the amount wouldn't likely be huge to pay. For a house, it isn't. For large sums of $ without documentation as to what spent on, you might have a transfer penalty issue. NH Medicaid is very costly for the states, so declining an application is better for the state. I do think the caseworkers really want to approve your elder for Medicaid, they want to work with you, but you have to provide them the documentation they need to sign off approved.

Keep in mind that you may have to do an annual recertification for them. I have to do one for my mom each Spring for TX. It specifically asks for information on their financials, insurance, property owned and if anything has been transferred or gifted. And I have to supply the last 4 months of bank statements and the new years SS letter and her annuity / retirement award letter too. About 20 pages and must be submitted within 13 days! Also there is the MERP (estate recovery) acknowledgement letter. You sign off that you are responsible if the state finds out stuff that you did not disclose. I just don't think it's worth the risk of not reporting $ gifted as you will have the NH and all the health care providers coming after you for payments if fraud or misrepresentation is found. Good luck!

My dad was on my account but I was the primary on the account and Medicaid did not consider this account as far as I know.

My dad is the primary on an account with my brother and Medicaid DID consider this account.

I'm assuming that you're talking about Medicaid. I can give you my experience. We applied in Jan. of this year. 5 years ago my dad had a lot of money. He was in mourning over my mom who had just died and ran away to Georgia. Somewhere along the line he came back with very little money and to this day we don't know what happened to it. But it was there and we worried ourselves sick that Medicaid would raise a ruckus over this money. Nary a ruckus was heard. :-)

We applied for vendor Medicaid which, in MO, means nursing home Medicaid. My dad gave me $8,000 prior to our application. Had Medicaid wanted to, they could have seen this money and wondered where it went. We never heard a word from them.

We didn't try to hide anything. In fact, we were scared to death that these things I've mentioned here would interfere with his being approved for Medicaid but we never heard a word about any of it. And the information we were given was that Medicaid would get their sticky little state-run fingers into everything. Maybe they did see all of this activity in my dad's accounts and saw that at the time of the application he was down to his last scheckel, I don't know. But we survived the look-back.

One way Medicaid advises applicants regarding the spend down is to purchase a funeral package. It's a good way to get rid of money so someone is eligible for Medicaid and when the time comes, all of that dreary business will be taken care of and you won't have to worry about it at a very difficult time in your life.

But these are just my experiences.