Georgia Nursing Home Medicaid: The Top 3 Things to Know

Medicaid continues to be the largest payer of nursing home care in Georgia.  The path to getting Medicaid, though, is confusing and cumbersome.

We have addressed many of the questions about Medicaid through our blog and newsletter. It’s hard to understand exactly how the rules apply to you and your family.

Here are the Top 3 Things to Know about Georgia Nursing Home Medicaid:

#1 You likely don’t make too much money to qualify for nursing home Medicaid.

“My mom needs nursing home care, but there’s no way she can afford it, and she makes too much money for Medicaid. What do I do?”

We hear some version of this question almost every day.

How do you know if you have too much income for Medicaid?  Georgia does have an income cap (or a maximum amount that you can make and still qualify for Medicaid). For 2019, that cap is $2,313/month of gross income.

This means that if you make more than $2,313 in monthly income, you are not eligible for Medicaid. Gross income includes all forms of income such as retirement checks, IRA distributions, rental income, etc.—all sources of income are counted towards the income amount.

With the average cost of nursing home care being around $8,500 in the Metro Atlanta area, this leaves many families scared about how they’re going to pay for the care they need. This makes it seem as if a person with a monthly income of $3,500 cannot qualify for Medicaid. How can they pay the $5,000 difference between their income and the cost of the nursing home?!?!

There is a special loophole—the Miller Trust.  Also known as a Qualified Income Trust, this loophole allows a person to still qualify for Medicaid even if their income is above the income cap.

If a nursing home resident makes more than $2,313/month but less than the private pay rate at the nursing home, they have to use a Miller Trust (or Qualified Income Trust) in order to qualify for Medicaid. This is an extra hoop that they have to jump through, but they can still be eligible for nursing home Medicaid.

For more information on the Qualified Income Trust, please click here.

In reality, a person can qualify for Medicaid as long as their income is less than the private pay rate of the nursing home.  In other words, as long as a person makes less than $8,500 in income (or whatever the cost is at their nursing home), they can qualify for Medicaid from an income standpoint. So, most of us do not make too much money to qualify for Nursing Home Medicaid in Georgia.

#2 You likely won’t lose your house to Medicaid.

In most cases your home is an exempt asset for Medicaid eligibility purposes.  In other words, you can usually own a home and still qualify for Medicaid. You can get on Medicaid while still owning a house.

You’ve probably heard about Medicaid Estate Recovery Program.

Our state does have a Medicaid Estate Recovery Program, and the state can make a claim against your estate (generally only real estate) for up to the value that Medicaid spent on your care. Fortunately, there are ways to protect your property and minimize your exposure to Estate Recovery.

Our blogs offer some great tips on avoiding Medicaid Estate Recovery. But you do have to do some planning and make a proactive decision.

#3 Your spouse’s income does not have to go to the nursing home.

We hear about this situation frequently: “I won’t have any money to live on if my husband gets on Medicaid. “My spouse has just transitioned from rehab to long-term care at a nursing home. They have been talking to me about Medicaid, but I’m scared that I will have no money to live on if he gets on Medicaid. Maybe I should just bring him home.”

Many spouses fear that they will have no money to live on if they try to pay for nursing home care for their ill spouse.

The $8,500 private pay cost or the idea of Medicaid seems intimidating and untenable.

Despite the cost, we encourage our clients to first focus on getting their loved one the right level of care. If your spouse needs nursing home care, let’s get that for him/her and then find a way to pay for it.

If your spouse needs nursing home level care and would do better there than at home (or if taking care of them at home would be too detrimental to you—also a very important consideration), there are ways to pay for the nursing home without going broke.

You may be eligible to receive a portion or all of your spouse’s income even if Medicaid is paying for the cost of his/her care. Georgia has a Monthly Maintenance Needs Allowance that protects the well spouse at home from impoverishment. In most situations, the spouse at home gets some or all of their institutionalized spouse’s income while Medicaid pays the majority of the nursing home costs.

You can learn more about how Medicaid works for couples here.

Seek professional guidance.

The Medicaid rules are confusing and ever-changing. To really understand how these rules apply to you, seek out an experienced, certified professional. The cost you pay up front for this guidance can save you thousands.

The team of professionals at Hurley Elder Care Law are experienced and certified.  You can learn more about what we do and how we can help you and your family by contacting us here or by calling us at 404-843-0121. Our phone consultations are always complimentary