While the rules of Medicaid eligibility for long-term care in Georgia are complex, this is meant to be a simple overview.
First, while Medicare can sometimes assist with initial skilled nursing charges, and only if certain prerequisites are met, Medicare does not cover long-term skilled nursing care, nor does traditional health insurance. Thus, unless an individual has long-term care insurance, he or she will either have to private-pay, or might seek Medicaid coverage for skilled nursing care.
Here are some of the basics of eligibility for nursing home Medicaid in Georgia:
- Applicant must be aged (65 or older), blind, or disabled
- Applicant must reside in a skilled nursing facility that participates in Medicaid for at least thirty continuous days
- Applicant must be a citizen or qualified legal alien
- Applicant must meet level of care requirement, i.e. intermediate or skilled nursing care in the facility
- Applicant must meet financial requirements.
In terms of financial requirements, applicants must be eligible in terms of income and resources. While the income limit in 2013 is $2,130, applicants with income greater than that amount can still qualify if a Qualified Income Trust (aka “Miller Trust” or “QIT”) is properly established and administered. Note that certain payments, such as VA Aid & Attendance benefits, are not counted as income.
The applicable resource limit depends on whether the applicant has a spouse in the community. Both the applicant’s resources and the spouse’s resources are counted together. In 2013, a single individual has a resource limit of $2,000, while an applicant and community spouse can keep a total of $117,920 in countable resources. Note that the following resources are not “countable,” and therefore do not apply towards the limit:
- Real or personal property listed for sale
- Income producing business property
- one vehicle per applicant
- retirement accounts such as IRAs, 401Ks, etc (if it is applicant’s account, he/she must be taking periodic payments which include a portion of the principal)
- certain annuities (generally must be irrevocable and actuarially sound based upon purchase price, equal monthly payments, and life expectancy and meet other requirements)
- burial/cemetery contracts may be partially or wholly excluded
- term life insurance
- burial exclusion ($10,000 per spouse may be applied towards burial exclusion, but limitations apply)
Note that this list is not exclusive.
Finally, transfers of assets for less than fair market value within the five years prior to the applicant qualifying and applying for Medicaid are penalized, unless an exception applies.
Note that planning for Medicaid eligibility is quite complicated, and it is not recommended that an applicant apply these provisions without the advice of competent legal counsel. This web site and the information contained herein have been prepared for educational purposes only. The information on this blog does not constitute legal advice, which would be dependent upon the specific circumstances of a particular case. In addition, because the law can vary from state to state some information on this site may not be applicable to you.
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