Medicaid – Southern Elder Law, PLLC

Medicaid is a maze of complicated government rules and regulations that pays for certain medical costs and long-term care costs. We often tell our clients that Medicaid is rocket science! Medicaid is a largely federally funded program that is administered by the Georgia Department of Community Health (DCH).

Medicaid is the payer of last resort. What this means is that you must exhaust all of your assets and any other benefits you may be receiving or entitled to receive before Medicaid will pay for your long-term care costs. There are strict asset, income, and other eligibility requirements for Medicaid. The Medicaid rules are complex and frequently change, requiring great skill in planning and applying for benefits.

The Federal Deficit Reduction Act, signed in 2006, significantly change the rules governing Medicaid eligibility. Most people start planning for Medicaid only when they perceive the need for receiving benefits, which is a huge mistake. Stringent rules govern the transfer of assets prior to qualifying (called the “look back period”). Currently, the look back period is 60 months.

For this simple reason, it is advised to apply for Medicaid at least 60 months prior to your need. If your income and assets are below specific levels and you are 65 years of age or older, legally blind, have a disability, need nursing home care, or are terminally ill, you may apply for Medicaid benefits directly with DCH. Because the Medicaid program is so complicated, having a Medicaid attorney to assist you with navigating this maze is critical.

In Georgia, an individual applying for Medicaid can only have $2,000 in total assets. If the individual or couple owns assets together, those assets are counted towards the couple’s resources. In addition, in Georgia, there is a monthly income limit for an individual. For married couples there are different income and asset limits depending on whether both spouses are in a nursing home or only one is.

The community spouse (the spouse who does not need nursing home care) may have up to $126,420 (2019) in assets and may receive income of up to $3,160.50 (2019) per month (some of the income to make up this amount is diverted from the nursing home spouse’s income).

If your income levels and assets exceed these limits and you want to qualify for Medicaid benefits sometime in the future, you should start your Medicaid planning NOW!

At Southern Elder Law, PLLC, we stand ready to assist in helping you navigate the complicated maze of rules and requirements.

No one wants to go into a nursing home, so we strive to help clients to remain independent, safe, and secure in their home. In Georgia, there are Medicaid options for long-term home care including the following:

Service Options for Using Resources in a Community Environment (SOURCE) is an enhanced primary care case management program that serves frail elderly and disabled beneficiaries. The program works to improve the health outcomes of persons with chronic health conditions, by linking primary medical care with home and community-based services through case management agencies. Beneficiaries who meet eligibility criteria enroll with a SOURCE site as their primary care provider who coordinates all medical and social services.
Georgia Money Follows the Person (MFP) is a rebalancing initiative that was made possible by an eleven-year grant to states from the Centers for Medicare and Medicaid Services (CMS). This grant is designed to help individuals who are institutionalized in in-patient facilities like nursing facilities; hospitals and intermediate care facilities for individuals with intellectual and developmental disabilities (ICF/IDD) return to their homes and communities.
Nursing Home Preadmission Screening and Resident Review (PASRR) screening is completed for all nursing home residents prior to admission or for any status change to determine if there are indicators of mental illness and/or mental retardation. This screening is intended to assess whether an individual is appropriate for nursing facility placement. The Level I screening is the first step to determine if there are positive indicators for mental health diagnosis or suspected diagnosis. Those who do not meet the Level I screening are referred for a Level II assessment. The Level II assessment determines if a nursing facility level of care is appropriate and if the individual requires additional mental health services during their nursing facility residency.
Hospice. Many people believe that hospice is merely for end-of-life care. However, hospice is much more than end-of-life care. Hospice is any organization that provides palliative, rather than curative, care for terminally ill persons. In Georgia, hospice services may be provided in the individual’s home or within a long-term care facility such as a nursing home.
At Southern Elder Law, PLLC, we know how to navigate the complicated maze of community care services available and the variety of service options offered everyday. We help our families manage their income and resources to remain independent, safe, and secure.

Transfer of asset rules

Quite simply put, you cannot transfer your assets within a certain time period in order to qualify for Medicaid. This is one of the primary rules that we deal with daily. When someone gives away money or assets and then seeks Medicaid benefits within a certain time period, those gifts are counted against them for a certain number of months (“the penalty period”). There are limited exceptions for transfers made to disabled children or caretaker children. We help people understand the best way to qualify for benefits by helping them with answers to a variety of questions, such as the following:

Can the nursing home take my house?
How can I protect my assets?
How can I protect my spouse?
I have put my children’s names on my bank accounts and CD’s. Are these assets protected from the nursing home?
My CPA said I could give my children $14,000 each year and not pay any tax, so why can’t I give my children this money and avoid the Medicaid penalty?
When does the Medicaid penalty period begin to run?
I have a revocable trust. How will Medicaid treat my trust?
Can Medicaid recover from a community spouse’s estate?
Are there any exceptions to the Medicaid eligibility rules?
What does Medicaid consider as an undue hardship?

We provide advice on Medicaid eligibility, prepare and file Medicaid applications, and represent clients in Medicaid denials, special claims, and estate recovery matters.