Medicaid is an extremely complicated government program that pays medical costs and long-term care costs. It is a Federal program that is administered by the Georgia Department of Community Health (DCH) in the state of Georgia. It pays medical bills with state and federal tax money and is designed to be a payer of last resort. That means that there are strict financial and other eligibility requirements and Medicaid managers seek to limit the number of people eligible for benefits and the amount of benefits paid.
The rules governing Medicaid are complex and change frequently, requiring great care in planning and applying for benefits. The Federal Deficit Reduction Act signed in 2006 significantly changed the rules governing Medicaid eligibility. Most people start planning for Medicaid only when they perceive the need for receiving benefits, which is a big mistake. Stringent rules govern the transfer of assets and the qualifying period (called the “look back period.”) For these reasons, it is prudent to plan for Medicaid at least five years prior to need.
If your income and assets are below specific levels and you are age 65 or older, legally blind, have a disability, need nursing home care, or are terminally ill, you may apply for Medicaid benefits directly with the Georgia Department of Community Health (DCH).
Income and Resource (Asset) Limits
In Georgia, an individual applying for Medicaid can have only $2,000 in total assets. If the individual or couple owns a home or other assets those assets will be counted toward that person’s or couple’s resources. In addition, in Georgia there is an income limit of $2,130 (2013) per month for an individual. For married couples, there are different income and asset limits depending on whether both spouses are in a nursing home or only one. The Community Spouse (the spouse who does not need nursing home care) may have up to $115,920 (2013) in assets and may receive up to $2898 (2013) per month in income under the Minimum Monthly Needs Allowance provisions if the Community Spouse's income is below that threshold.
If your income level and assets exceed these limits and you want to qualify for Medicaid benefits sometime in the future, you should be engaged in Medicaid Planning at the earliest opportunity. At Smith Barid we stand ready to assist in helping you navigate the complex rules and requirements.
Medicaid Waiver Programs
One of the primary goals expressed by many aging people is to remain in their own homes, or at least in the most independent setting possible In Georgia, there are Medicaid options for long-term home care including the following:
- Service Options Using Resources in a Community Environment (SOURCE), serves the elderly and disabled with chronic health conditions by linking primary medical care with home and community-based services. This program builds on the state’s primary care case management program, Georgia Better Health Care Program (GBHC).
- Money Follows the Person (MFP), an initiative made possible by a grant from the Centers for Medicare and Medicaid Services, which helps individuals in nursing facilities and intermediate care facilities to return to their homes and communities. Georgia implemented MFP in 2008 and seeks to transition individuals from institutional settings.
- Nursing Home Pre-Admission Screening and Resident Review (PASRR),which is completed for all nursing home residents prior to admission, or for any status change, to determine if there are indicators of mental illness and/or retardation. In Georgia, this screening is intended to assess whether an individual is appropriate for nursing facility placement and the level of care that is appropriate.
- Hospice, any organization that provides palliative, rather than curative, care for terminally ill individuals. In Georgia, hospice services may be provided in the individual’s home or within a long-term care facility such as a nursing home.
At Smith Barid we know how to navigate the maze of community care services available in the variety of service options offered and help people manage their income and resources to maximize their value through Medicaid Planning.
Transfer of Asset Rules
What if an individual gives assets away in order to qualify? As might be expected, there are rules governing such transfers. This is one of the main areas where the rules changed in 2006. When someone gives away money or assets s/he and that individual’s spouse may be ineligible for Medicaid for a certain number of months (“the penalty period”). Exceptions are made for transfers to certain individuals such as a disabled child or caretaker children.
We can help people understand the best way to qualify for benefits by helping them with answers to a variety of questions, such as the following typical questions people have:
- Who qualifies for Medicaid?
- How far back does Medicaid look to find asset transfers?
- Can Medicaid take my house?
- How is the penalty period calculated?
- When does the penalty period begin to run?
- How does Medicaid treat jointly held assets?
- How does Medicaid treat Trusts?
- Can Medicaid recover from a beneficiary’s estate?
- Can Medicaid recover from a community spouse’s estate?
- Are there any exceptions to the Medicaid eligibility rules?
- What does Medicaid consider an undue hardship?
Smith Barid provides advice on Medicaid eligibility, prepares and files Medicaid applications, and advocates and litigates for Medicaid denials, spousal claims and estate recoveries. For more information on Medicaid Planning, check out articles on the topic on our blog or use the Contact Us form on this website to start discussions about your Medicaid eligibility today.