Georgia Medicaid Eligibility for Long Term Care: Income & Asset Limits

Georgia Medicaid Long-Term Care Definition

Medicaid is a medical assistance program for low-income people of all ages. While this program provides health coverage for many diverse groups of Georgia residents, this page is focused on long-term care Medicaid eligibility for seniors. In addition to nursing home care, services and supports are available to help the elderly remain living at home or in a personal care home / assisted living facility. There are three categories of Medicaid long-term care programs for which Georgia seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; 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) – Not an entitlement; there is an enrollment cap. This means the state limits the number of program participants. Services and supports are intended to prevent and delay nursing home admissions and may be provided at home, adult day care, or in assisted living.

3) Regular Medicaid / Aged, Blind or Disabled – An entitlement; meeting the eligibility requirements ensures one receives benefits. A variety of long-term care services, such as personal care assistance or adult day care, may be available.

While GA Medicaid is jointly funded by the state and federal government, it is administered by the state under federally set parameters. The Georgia Department of Community Health (DCH) is the administering agency.

Income & Asset Limits for Eligibility

Each of the three Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change each year, vary based on one’s marital status, and is further complicated by the fact that Georgia offers multiple pathways towards Medicaid eligibility.

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 of the criteria does not mean one is ineligible or cannot become eligible for Georgia Medicaid. More.

Income Definition & Exceptions

Countable vs. Non-Countable Income
Nearly all income that a Medicaid applicant receives is counted towards Medicaid’s income limit. This includes employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in GA, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, is not counted.

Treatment of Income for a Couple
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 count towards the applicant spouse’s income eligibility. The non-applicant spouse, however, may be entitled to a Monthly Maintenance Needs Allowance (MMNA) from their applicant spouse to prevent spousal impoverishment.

The MMNA is the minimum amount of monthly income to which a non-applicant spouse is entitled. In 2024, the MMNA in GA is $3,853.50. If the non-applicant’s monthly income falls below this amount, income can be transferred from the applicant to the non-applicant spouse to bring their income up to this level. A non-applicant spouse whose own income is $3,853.50 / month or greater is not entitled to a MMNA / Spousal Income Allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged, Blind or Disabled Medicaid. The income of both spouses is counted towards the applicant spouse’s income eligibility. Furthermore, there is no Minimum Monthly Maintenance Needs Allowance for the non-applicant spouse. More on how income is counted for Medicaid eligibility.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets
Countable (non-exempt) assets are calculated towards Medicaid’s asset limit. This includes cash, stocks, bonds, investments, bank accounts (savings, checking, and credit union), and real estate in which one does not reside. There are also many assets that are non-countable (exempt). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. In Georgia, IRA’s and 401K’s of applicants are exempt if they are in “payout status”. This means that one’s Required Minimum Distribution (RMD) is being withdrawn. IRA’s / 401’s of non-applicant spouses are automatically exempt.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. There is, however, a Community Spouse Resource Allowance (CSRA) that protects a larger amount of a couple’s countable assets for the non-applicant spouse of a Nursing Home Medicaid or Medicaid Waiver applicant. In 2024, the community spouse (the non-applicant spouse) can retain up to $154,140 of the couple’s countable assets. For Regular Medicaid, there is no CSRA for a non-applicant spouse.

Medicaid’s Look-Back Rule
Georgia has a Medicaid Look-Back Period of 60 months for Nursing Home Medicaid and Medicaid Waivers that immediately precedes one’s application date. During this period, Medicaid checks to ensure no assets were sold or gifted under fair market value. This includes asset transfers made by one’s spouse. This rule is meant to discourage persons from gifting assets in order to meet Medicaid’s asset limit. Violating the Look-Back Rule results in a Penalty Period of Medicaid ineligibility. There is no Look-Back Period for Regular Medicaid applicants.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, the Gift Tax Rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s 5-year Look-Back Period.

Georgia Medicaid Home Exemption Rules

For the home to be exempt, the Medicaid applicant or their spouse must live in it. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is no spouse in the home, and the Medicaid applicant does not live in it, the applicant must have “Intent to Return”. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program (MERP). Following a long-term care Medicaid beneficiary’s death, GA’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

An applicant must have a medical need for Medicaid long-term care. For Nursing Home Medicaid and Medicaid Waivers, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, some Waiver program benefits may have additional eligibility requirements specific to the particular benefit. As an example, for a Medicaid Waiver to cover respite care, it may be required that one cannot be safely left at home unattended. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

For Georgia residents, 65+ years of age, who do not meet the financial eligibility requirements above, there are other ways to qualify for long-term care Medicaid.

1) Medically Needy Pathway – The Aged, Blind and Disabled Medically Needy Program allows Georgia seniors to still qualify for Regular Medicaid even if they are over the income limit. Also called a “spend down” program, “excess” income goes towards medical bills, such as health insurance premiums, medical supplies, and hospital bills. The “spend down” amount, which can be thought of as a deductible, is the difference between one’s monthly income and GA’s Medically Needy Income Limit (MNIL). In 2024, the MNIL is $317 / month for a single individual and $375 / month for a couple. In GA, the spend down amount is calculated for a 6 month period. Once the “spend down” is met, one is income-eligible for Medicaid the reminder of the period. The Medically Needy Program also has asset limits, which are $2,000 for an individual and $4,000 for a couple.

2) Qualified Income Trusts (QIT’s) – Also called Miller Trusts, these trusts allow Nursing Home Medicaid and Medicaid Waiver applicants with income over Medicaid’s limit to still become income-eligible. Medicaid does not count income deposited into an irrevocable QIT towards Medicaid’s income limit. Irrevocable means the terms of the trust cannot be changed or canceled. Essentially, one’s “excess” income is directly deposited into the trust, in which a trustee is named, giving that person legal control of the money. 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 the state will receive any remaining funds in the trust, up to the amount the state paid for care, after the Medicaid beneficiary’s death.

3) Asset Spend Down – Seniors who are over GA Medicaid’s asset limit can reduce their countable assets by “spending down” extra assets on non-countable ones. Examples include vehicle and home modifications (wheelchair ramps, roll in showers, and stair lifts), home repair (upgrading plumbing and replacing the roof), Irrevocable Funeral Trusts, 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 assets were spent as evidence this rule was not violated.

4) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, 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.   Connect with a Medicaid Planner.

Specific Georgia Medicaid Programs

In addition to paying for nursing home care, Medicaid in Georgia offers three 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) – 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. CCSP 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 and also operates under the Elderly and Disabled Waiver Program. However, to be eligible for SOURCE, an applicant must be eligible for SSI.

3) Money Follows the Person (MFP) – This federal program helps institutionalized persons who are eligible for Medicaid to transition back home or into the community.

How to Apply for Georgia Medicaid

GA seniors can apply for long-term care Medicaid online at Georgia Gateway, in-person at their county Division of Family and Children Services (DCFS) office, or by calling DCFS at 877-423-4746. For additional program information or for application assistance, persons can call DCFS or contact their local Area Agency on Aging office. The application process may vary based on the program for which one is applying.

Before applying for Medicaid, it is imperative that seniors are confident that they meet all of the financial 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. Familiarizing oneself with general information about the application process can be helpful.