Individuals, Income, and Georgia Medicaid Rules

Over the last few months, we’ve addressed the top questions about nursing home Medicaid for couples. Today, let’s take a closer look at Medicaid rules for individuals by focusing on the income rules. Medicaid is a means-tested, government-provided health insurance benefit. It is the largest payer of nursing home care in Georgia. Most nursing home residents in Georgia rely on Medicaid to help pay some of the costs, but they do have a cost-share. The nursing home resident pays all of their income to the nursing home (with a few exceptions), and Medicaid pays the difference.

There are strict rules about who can qualify for nursing home Medicaid. The state of Georgia has an income cap limit on Medicaid eligibility of $2,205/month. So, does this mean that if you make $3,000 a month you cannot qualify for Medicaid? In Georgia, the average cost of a nursing home bed for long-term care is $6,175 (it is closer to $8,000/month in the Metro Atlanta area). How is a person supposed to make up that $3-5,000 difference between their income and the cost of the nursing home? In reality, a nursing home resident can be eligible for Medicaid if the resident’s income is below the private pay rate of the nursing home. So in most cases, a person must make less than $6,175/month in order to qualify for Medicaid. That’s much higher than you expected, right? Most people think that Medicaid is only for the very low-income citizens in our communities.

If a nursing home resident makes over the $2,205/month income cap set by Georgia but less than the private pay rate at the nursing home, a Qualified Income Trust (or Miller Trust) must be used to be eligible for Nursing Home Medicaid. A Qualified Income Trust (QIT) only handles the resident’s income (it’s not like most Trusts that deal with assets); and it’s just a hoop that must be jumped through in order to get Nursing Home Medicaid if your income exceeds the Income Cap. More on the QIT next week. In the meantime, if you have any questions or concerns, please contact us at (404) 843-0121 or at https://hurleyeclaw.com/contacts/