Hawaii reviews five years of financial history — 60 months — when someone applies for long-term-care Medicaid. Under the state's long-term-care asset regulation, an applicant can face a penalty period if the applicant or their spouse gave away an asset, or sold it for less than it was worth, at any point within that look-back window. For any transfer made on or after February 8, 2006, the applicable review period is set at 60 months under Hawaii Administrative Rules section 17-1725.1-51.
It's worth being precise about what a transfer penalty actually is: it isn't a fine or a tax bill. It's a stretch of time during which Medicaid won't pay for long-term-care services, even if the applicant otherwise qualifies medically and financially. Because Hawaii's rule reaches both the applicant's and the spouse's below-market transactions, the exact date of a transfer, its value, who owned it, what (if anything) was received in return, and the paper trail documenting all of that will all matter if the case is ever reviewed.