Nursing Home Medicaid for Individuals

Last week, we answered some of the most common questions about Medicaid planning for couples. Today, we’re focusing on Nursing Home Medicaid rules for individuals, specifically income limits and how they affect eligibility.

What Is Nursing Home Medicaid?

Medicaid is a government-funded health insurance program that helps cover the cost of long-term care for those who qualify. In Georgia, Medicaid is the largest payer of nursing home care. However, it’s not entirely free—nursing home residents on Medicaid must contribute nearly all their income to the facility (with a few exceptions), and Medicaid covers the remaining costs.

How Much Income Is Too Much for Medicaid?

Georgia has strict income limits for Medicaid eligibility. The current cap is $2,901 per month. While that might sound like a clear-cut rule, it’s not quite that simple.

You might be wondering: If someone makes $3,000 a month, does that mean they don’t qualify for Medicaid? The answer is no—because nursing home care is expensive. The average cost of a nursing home in Georgia is $10,025 per month, and it’s often over $11,000 in Metro Atlanta.

Most people can’t afford to pay at least $7,000 to $10,000 out-of-pocket monthly for care. The good news? A person can still qualify for Medicaid as long as their income is below the private pay rate of the nursing home. In most cases, someone making less than $10,025 per month can still qualify. A number much higher than many expect.

What If My Income Is Over the Limit?

If a nursing home resident’s income is higher than the $2,901/month cap but still less than the actual cost of care, they must use a special type of trust to become eligible for Medicaid. This is called a Qualified Income Trust (QIT), also known as a Miller Trust.

A QIT only manages income

Unlike other trusts that typically deal with assets. Essentially, it’s a required legal tool that helps redirect income in a way that allows someone to qualify for Medicaid while ensuring the nursing home gets paid. I describe it as an extra hoop to jump through, but it’s often the key to unlocking Medicaid coverage for those who would otherwise be ineligible.

Need Help?

Understanding Medicaid rules can be complicated, but you don’t have to figure it out alone. If you or a loved one are navigating nursing home Medicaid, we can help guide you through the process and explore all available options. Call Hurley Elder Care Law at 404-843-0121 to schedule an appointment at one of our four convenient office locations (Atlanta, Duluth, Peachtree City and Woodstock).