Georgia Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal medical assistance program for low-income people of all ages. Many groups of people are covered, including children, families, and pregnant women, but on this page, the focus will be on Medicaid eligibility for Georgia senior residents (65 years of age and older). Specifically, the focal point will be for long-term care, whether that be in the home, in a nursing home or in an assisted living facility. In the state of Georgia, the Georgia Department of Community Health (DCH) administers the Medicaid program.
Income & Asset Limits for Eligibility
There are a number of different Medicaid long-term care programs for which Georgia seniors may be eligible. These programs have slightly different eligibility requirements, as well as benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Georgia offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) and is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – there is an enrollment cap (limited number of participants) and services are provided at home, adult day care or in assisted living.
3) Regular Medicaid / Aged, Blind and Disabled – is an entitlement and is provided at home or adult day care.
Again, eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Georgia offers multiple pathways towards eligibility. The table below provides a quick reference to allow Georgian seniors to determine if they are immediately eligible for long term care from a Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 Georgia Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$3,375 / month||$3,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Help w/ 2 ADLs||$3,375 / month||$3,000||Help w/ 2 ADLs||$2,250 / month for applicant||$2,000 for applicant & $123,600 for non-applicant||Help w/ 2 ADLs|
|Regular Medicaid / Aged Blind and Disabled||$1,005 / month||$2,000||None||$1,103/ month||$3,000||None||$1,005 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
One should be aware that Georgia has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Georgia residents at least 65 years of age and older and who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit for other pathways toward Medicaid eligibility. In Georgia, this program is called the Aged, Blind and Disabled Medically Needy Program, and via this pathway for eligibility there is no maximum income limit. This means that regardless of one’s income level, eligibility through the Medically Needy Pathway is possible if one has high medical bills in relation to their income level. Sometimes referred to as a “Spend-down” program, the way this program works is one’s “excess income,” (income over the Medicaid eligibility limit), is used to cover medical bills, which may include nursing home bills. Georgia has a one-month “spend-down” period. This means that once an individual has paid their excess income down to the Medicaid eligibility limit for the month, one will qualify for Medicaid for the remainder of the month. Like with the other pathways for Medicaid eligibility, there are asset limits for the Medically Needy Program. These limits are $2,000 for an individual and $4,000 for a married couple in which both spouses are applying for Medicaid.
Unfortunately, Georgia’s Aged, Blind and Disabled Medically Needy Program does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as vehicle and home modifications (wheelchair ramps, roll in showers, and stair lifts), home repair (upgrading plumbing and replacing the roof), and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Georgia Medicaid Programs
In addition to paying for nursing home care, Medicaid in Georgia offers two programs relevant to the elderly that helps them to remain living in their homes or in assisted living residences.
1) Community Care Services Program Waiver (CCSP) – This waiver offers support for seniors in a variety of locations including at home, in assisted living and adult day care. It also allows for consumer direction of services, meaning participants can choose some of their own care providers.
2) Service Options Using Resources in a Community Environment (SOURCE) Waiver – SOURCE is very similar in the benefits provided to CCSP. However, it does not allow for consumer direction.