Georgia Medicaid Definition
Medicaid is a wide-ranging, jointly funded state and federal medical assistance program for low-income people of all ages. While many groups of people are covered, including children, families, and pregnant women, the focus on this page is on Medicaid eligibility for Georgia senior residents (65 years of age and older). Specifically, it covers long-term care, whether that be in one’s home, a nursing home facility, or a personal care home / assisted living facility.
The Georgia Department of Community Health (DCH) administers Georgia’s 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 – This is an entitlement program; Anyone who meets the eligibility criteria will receive assistance. Benefits are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; There is an enrollment cap, which means the state limits the number of participants. Services are intended to delay the need for nursing home care and are provided at home, adult day care, or in assisted living. Additional information about Medicaid Waivers here.
3) Regular Medicaid / Aged, Blind and Disabled – This is an entitlement program; Meeting the eligibility requirements ensures one receives benefits. A variety of long-term care services are available and may include personal care assistance or adult day care.
The table below provides a quick reference to allow Georgian seniors to determine if they might immediately be eligible for a Medicaid-funded long-term care program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria below does not mean one is ineligible or cannot become eligible for Georgia Medicaid. More.
|2022 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||$2,523 / month*||$2,000||Nursing Home||$5,046 / month ($2,523 / month per spouse)*||$3,000||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,523 / month||$2,000||Nursing Home||$5,046 / month ($2,523 / month per spouse)||$3,000||Nursing Home||$2,523 / month for applicant||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$841 / month||$2,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs||$1,261 / month||$3,000||Help with ADLs|
What Defines “Income”
Any income that a Medicaid applicant receives is counted. This income can come from any source and includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Covid-19 stimulus checks and Holocaust restitution payments are not considered income and do not impact Medicaid eligibility.
When only one spouse of a married couple applies for nursing home Medicaid or a HCBS Medicaid Waiver, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the applicant spouse’s income eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the applicant spouse to prevent spousal impoverishment.
The MMMNA is the minimum amount of monthly income to which a non-applicant spouse is entitled. In 2022, the MMMNA in GA is $3,435. If the non-applicant’s monthly income is under $3435, income can be transferred from the applicant spouse to the non-applicant spouse to bring their income up to this level. A non-applicant spouse who already has a monthly income of $3,435 or greater is not entitled to a MMMNA / spousal income allowance.
Income is counted differently when only one spouse applies for regular Medicaid / Aged, Blind and Disabled Medicaid. In this case, the income of both spouses is considered towards the applicant spouse’s eligibility. Learn more about how income is counted for Medicaid eligibility.
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. There are also many assets that are exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For the home to be exempt, the Medicaid applicant must live in it or have “intent to return”, and their home equity interest must be under $636,000 (in 2022). Home equity interest is the value of the home, minus any debt against it, in which the applicant owns. If a non-applicant spouse lives in the home, it is exempt regardless of the above circumstances. Furthermore, for a senior applying for regular Medicaid, there is no home equity limit.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a nursing home Medicaid or HCBS Medicaid Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can retain up to $137,400 of the couple’s joint assets, as shown in the chart above.
Georgia has a Medicaid Look-Back Period of 60 months that immediately precedes 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 violates the look-back period, a penalty period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Georgia residents 65+ years of age who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – The Aged, Blind and Disabled Medically Needy Program in GA allows seniors to qualify for regular Medicaid even if they are over the income limit. 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 comparative to their income level. Also called a “Spend-down” program, one spends their “excess” income on medical bills, such as health insurance premiums, medical supplies, and hospital bills. Once their income is “spent down” to the medically needy income limit (MNIL), they qualify for Medicaid for the remainder of the month. In 2022, the medically needy income limit (MNIL) is $317 / month for a single individual and $375 / month for a couple. The Medically Needy Program also has asset limits, which are $2,000 for an individual and $4,000 for a couple. Learn more about the medically needy pathway.
2) Qualified Income Trusts (QIT’s)– Also called Miller Trusts, QITs are for nursing home and Medicaid Waiver applicants who are over the income limit. QITs offers a way for Georgia residents to become income-eligible and qualify for Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s “excess” income is directly deposited into the irrevocable trust, in which a trustee is named, giving that person legal control of the money. Irrevocable means the terms of the trust cannot be changed or canceled. Trust funds can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee. The state of GA must be listed as the remainder beneficiary. This means that following the death of the Medicaid recipient, the state will receive any remaining funds in the trust, up to the amount the state paid for care.
3) Asset Spend Down – Seniors who are over GA Medicaid’s asset limit can reduce their countable assets by “spend downing” extra assets. This can be done 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), buying a funeral trust, and paying off debt. Remember that assets cannot be gifted or sold under fair market value, as it violates Medicaid’s look back rule. When “spending down”, it is best to keep documentation of how the assets were spent as evidence the look back period was not violated.
Our spend down calculator can assist persons in determining if they might have a spend down, and if so, provide an estimation of the amount. Find out if you might have a spend down.
4) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of long term 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 as well as to protect their home from Medicaid’s estate recovery program. 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 (CCSP) – CCSP operates under the Elderly and Disabled Waiver Program (EDWP) through which support for seniors is available in a variety of locations. This includes at home, in assisted living (personal care home), and adult day care. This program 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, to be eligible for SOURCE, an applicant must be eligible for SSI.
How to Apply for Georgia Medicaid
For additional information about the Medicaid programs offered in Georgia or to apply for benefits, seniors can contact their county Division of Family and Children Services (DCFS) office. Contact information can be found here. Alternatively, one can call DCFS at 1-877-423-4746. Medicaid applicants can complete the application process online at Georgia Gateway. Finally, local Area Agency on Aging offices can also provide Medicaid program information and assist with the application process.
Before applying for Medicaid, it is imperative that seniors are confident that they meet all of the eligibility requirements covered above. For those who do not, or are unsure if they do, Medicaid planning can play an instrumental role. Applying for long-term care Medicaid is often a complicated and lengthy process. For general information about applying for long-term care Medicaid, click here.