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, which means anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – there is an enrollment cap. This means the state limits the number of participants. Services are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged, Blind and Disabled – is an entitlement. Therefore, meeting the eligibility requirements ensures one can receive benefits. Services are 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 might immediately be eligible for long term care from a Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Georgia Medicaid. More.
|2019 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||$2,313 / month||$2,000||Nursing Home||$4,626 / month (Each spouse can have income up to $2,313 / month)||$3,000||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$2,000||Help w/ 2 Activities of Daily Living (ADLs)||$4,626 / month (Each spouse can have income up to $2,313 / month)||$3,000||Help w/ 2 Activities of Daily Living (ADLs)||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Help w/ 2 Activities of Daily Living (ADLs)|
|Regular Medicaid / Aged Blind and Disabled||$771 / month||$2,000||None||$1,157/ month||$3,000||None||$771 / 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. Learn more about how income is counted for Medicaid eligibility. 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 January 2019, this figure can be as high as $3,160.50 / 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 his or her spouse lives in the home and the home is valued under $585,000 (in 2019). For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain up to a maximum of $126,420 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 needy eligibility limit), is used to cover medical bills, which may include health insurance premiums, medical supplies, and hospital bills. Georgia has a one-month “spend-down” period. This means that once an individual has paid their excess income down to the Medicaid needy eligibility limit for the month, he or she 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.
2) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are for nursing home and Medicaid waiver applicants who are over the income limit, but still cannot afford to pay their cost of long-term care. This type of trust offers a way for Georgia residents over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s income in excess of the Medicaid limit is directly deposited into a trust, in which a trustee is named, giving that person legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and must have the state of Georgia listed as the remainder beneficiary. (This means the state will receive the remaining funds in the account following the death of the Medicaid recipient, up to the amount the state paid for care). In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee.
Unfortunately, Georgia’s Aged, Blind and Disabled Medically Needy Program, nor Miller Trusts, 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, nor trust, is able to assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable ones, 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.
3) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they 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 via CCSP. However, it does not allow for consumer direction.