How Does Tithing Income to a Church Impact Medicaid Eligibility?

Summary
The act of tithing, giving income or other funds to a church, could make you ineligible for Medicaid Long Term Care. That’s because applicants are not allowed to simply give away their money so they can meet Medicaid’s financial requirements and qualify for care. If they do give away funds in order to qualify, their application will be denied and they will be penalized with a period of ineligibility. However, if seniors have a long-term pattern of tithing, it may be allowed by Medicaid.

 

Relevance of the Look-Back Period on Church Tithes

To make sure applicants don’t give away money, or sell any assets at less than fair market value, to meet its financial requirements, Medicaid uses the Look-Back Period. In most states, the Look-Back Period is 60 months (5 years). This means the state will “look back” into the applicant’s financial history for the 60 months prior to their application date to see if they’ve given away any income or assets, or sold them at less than fair market value.

There are three types of Medicaid Long Term Care – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid. To learn more about them, click here. For the purposes of this article, it’s important to know that the Look-Back Period does not apply to ABD Medicaid. However, ABD Medicaid applicants should be careful about giving away assets, including church tithes, because they may eventually need Nursing Home Medicaid or HCBS Waivers and giving away assets could make them ineligible for those two programs.

The Look-Back Period exceptions are New York and California. In New York, the Look-Back Period is for Nursing Home Medicaid is the standard 60 months, but there is no Look-Back Period for New York’s Community Medicaid (similar to HCBS Waivers in other states), although this may change in 2025. In California, there is no Look-Back Period for HCBS Waivers and it’s 30 months for Nursing Home Medicaid, although that will be phased out by July 2026.

When it comes to church tithes, they will look like gifts to the state as it looks back into the financial records of Medicaid Long Term Care applicants, and they could lead to the application being denied and penalty period of ineligibility. The length of that penalty period (it could be months or even years) is calculated using a “penalty divisor,” which can vary by state. Some states also take into account the amount of money that was found to be in violation of the Look-Back Period in the penalty calculations.

However, church tithes may not be considered a Look-Back violation if the applicant can show a consistent, long-term pattern of tithing, which we will detail next.

 

Making Church Tithes Medicaid-Allowed

Tithing is a long-standing tradition in many churches. In Christian churches, it’s often defined as giving 10% of your income to the church.

In order for Medicaid to allow these tithes and not declare them a violation of the Look-Back Period, the applicant must prove they have giving tithes to their church for an extended period of time. For example, if one has been tithing every since they were 30 and they are now applying for Medicaid at age 78, the tithes given during the Look-Back Period will likely be allowed by the state and will not disqualify the applicant. However, if an applicant can only prove they’ve been tithing for the last three years, those tithes might look like an attempt to get under Medicaid’s asset limit, which would be a violation of the Look-Back Period and lead to the application being denied and a period of ineligibility.

Collecting Documents

To establish a consistent, long-term pattern of tithing, Medicaid Long Term Care applicants will need financial documents as proof. These could be tax returns, cashed checks or receipts from the church, but they need to be complete and clear. The burden of proof is on the applicant to establish the pattern.

 

Appeals and Other Options

Most states will allow applicants to file an appeal if they have been found in violation of the Look-Back Period. This includes if the violation is because of a church tithe and the applicant believed they had compelling evidence of a consistent, long-term tithing pattern.

Look-Back Period penalties can also be overturned (or reduced) in some states if the applicant is able to retrieve all (or some) of the money that was given away and caused the Look-Back violation. This may be difficult when it comes to a church tithe.

Many states also grant Undue Hardship Waivers when it comes to Look-Back violations. If a state allows for Undue Hardship, the Look-Back penalty is usually dropped and the applicant will be accepted into their Medicaid Long Term Care program and begin receiving benefits. Some common criteria for Undue Hardship in many states include attempting to recover the violating assets, being unable to receive medical care without Medicaid and if one’s health and safety would be in danger without Medicaid benefits.