Medicaid Planning in Georgia
Do You Need Help Paying for Nursing Home Care?
How can I pay for nursing home care?
There are basically five ways that you can pay for the cost of a nursing home:
- Rely on Medicare— Medicare does pay for some nursing home care as long as you are receiving rehab or certain skilled services. Medicare does not pay for long-term (or custodial) care in a nursing home.
- Use Long-Term Care Insurance– If you are fortunate enough to have this type of coverage, it may go a long way toward paying for the cost of the nursing home.
- Pay With Your Own Funds– This is the method many people choose first. Quite simply, it means paying for the cost of a nursing home out of your pocket. Unfortunately, with nursing home bills averaging between $8,000 and $10000 per month in our area, few people can afford a long-term stay in a nursing home.
- Apply for VA Assistance – This type of benefit may be available to someone over 65 years of age or is disabled, who either served in the military or is a surviving spouse of someone who served in the military. VA special pensions can help pay nursing home bills. Hurley Elder Care Law attorneys are accredited with the VA to provide more information on VA special pensions.
- Apply for Medicaid– This is a primarily federally funded and state administered program that pays for the cost of the nursing home if certain asset and income requirements are met.
Does Medicare pay for nursing home care?
Medicare is the federally-funded health insurance program primarily designed for individuals over age 65. There is a limited long-term care component to Medicare. In general, if you have had a hospital inpatient stay of at least three days, and then you need to go into a skilled nursing facility (for rehabilitation), then Medicare may pay for up to 100 days of skilled nursing care. If you have met the proper criteria, Medicare will pay the full cost of the nursing home stay for the first 20 days and will continue to pay the cost of the nursing home stay for the next 80 days (but with a deductible that’s $185 per day in 2021). In order to qualify for coverage, however, the nursing home resident must continue to meet Medicare criteria. It is never possible to predict how long Medicare will cover the “rehabilitation.” From our experience it often falls far short of the 100 day maximum, but they cannot end coverage because you have “plateaued.” Also be aware that if you have a Medicare Advantage Plan, your coverage may be even more limited. Medicare Advantage Plans must offer nursing home coverage, but they can offer these benefits differently than traditional Medicare. Medicare only pays for limited nursing home care. If you need long term care in a nursing home, you will have to use your own income and assets, long term care insurance, VA benefits, or Medicaid to pay for care.
Isn't Medicaid only for the extremely poor?
Medicaid is a means-tested, government-provided health insurance benefit. It is the largest payer of nursing home care in Georgia. It is also commonly misunderstood. For instance, many people believe that they may have too much income for Medicaid. It is true that Georgia has an income cap. For 2021, that income cap is $2,382. This cap, however, does not mean that if a person makes over $2,382/month that he/she cannot qualify for nursing home Medicaid in Georgia. For nursing home residents that have an income higher than the $2,382 income cap, they must use a Qualified Income Trust (or Miller Trust).
What is a Miller Trust?
What are the requirements of a Miller Trust?
How does the Miller Trust Account receive income?
How can money in the Miller Trust account be spent?
Is your loved one a Medicaid applicant or recipient that has been denied coverage?
Will I Lose My Home?
Atlanta’s Top 10 Medicaid Myths
1| You will lose your house.
That is simply not true. You are allowed to own a home, a vehicle, have a retirement account, a burial plan and/or burial account (up to $10,000) and $2,000 in a bank account and still qualify for Nursing Home Medicaid. A married couple can have $130,380 thanks to the community spouse resource allowance.
Of course, there are rules and regulations you have to follow in order to keep and maintain these items but nonetheless they are ALLOWABLE!! There are also a lot of options when it comes to financial planning for citizens with more than the $2,000 resource limit.
2| Medicaid is free.
Medicaid is not free for anybody, anywhere in the United States. You, as a non-married individual living in a nursing home, contribute your monthly income toward your monthly bill. This is your patient liability. If you are married, your spouse living in the community may be able to keep some (or all) of your income, depending on the circumstances. Medicaid will pay the facility the remaining cost of your care. That’s care for seven days a week, 24 hours a day. It also includes all your meals, bathing, dressing, medications, activities, etc.
3| Someone can gift up to $14,000 and not get penalized.
Medicaid does not allow for gifting of any kind. Medicaid is not the IRS; they have very different rules. Medicaid has a look-back period of five years. It’s true that if you gave money away within five years of the date you are asking for Medicaid, it is considered a transfer. Gifts and transfers are one and the same for Medicaid purposes. Either the gift has to be given back OR you have a penalty period before Medicaid will pay your nursing home bill, (approximately one month for every $8,517 gifted/transferred). Please remember that an Elder Lawyer can help you navigate through all of this and still qualify you for benefits.
4| Medicaid is for extremely poor people, and I have too much money to qualify.
Many people cannot afford to pay $8,000–10,000 per month for the cost of a nursing home. Even those who can pay for a while may find their life savings wiped out in a ma er of months, rather than years. We cannot say it enough – everybody’s circumstances are different. If you are married, it matters. Having a disabled sibling or child matters. Fortunately, the Medicaid program is there to help. In fact, in our lifetime, Medicaid has become the long-term care insurance of the middle class.
If your income is above the income cap (or $2,382 in 2021), you must use a Qualified Income Trust to qualify for Medicaid. You can only have too much income for Medicaid if you make over the private pay rate of the nursing home, or over $8,000-10,000 in Metro Atlanta.
5| Medicaid only knows what I tell them.
Once a Medicaid application is submitted to the Department of Family and Child Services (DFCS), it is the responsibility of the Social Service Examiner to “investigate” the applicant. This includes property searches, financial reports, and income verifications as well as other items. More times than not, this is what gets a citizen’s application denied. If DFCS finds any documentation on their checklist that was not submitted, they can and will deny the application for benefits.
6| Nursing Home Medicaid is only given to senior citizens.
There are people in need of Medicaid that are not over 65. Unforeseen circumstances happen all the time. Anyone that needs a skilled nursing facility may be eligible for Nursing Home Medicaid no matter the age of the person.
7| I won't have any money to pay for my funeral.
Medicaid recipients are allowed to set money aside to take care of their final arrangements. Currently, you can set aside up to $10,000 in a burial fund and still qualify for Medicaid.
8| I have to spend down to $2,000.
This is not true. You cannot have more than $2,000 in countable assets, but they do not necessarily have to be spent down. As stated above, there are many methods of planning which can preserve your assets. Please see an Elder Care Lawyer for assistance.
9| Medicaid Estate Recovery will come after everything.
Medicaid Estate Recovery is what happens after the death of a Medicaid beneficiary who received help with long term services and supports (e.g., nursing home and home and community-based services). It is true that if you have an estate valued at more then $25,000 at the time of death, Medicaid will try and recoup any benefits that they paid out on your behalf. However, with careful planning and the advice of an Elder Care Lawyer beforehand, there are methods of preserving an estate and making certain that the estate of the citizen will not be available for Estate Recovery.
It is also worth noting that in 2018, Georgia passed a new law protecting the first $25,000 of a Medicaid beneficiary’s estate from Medicaid Estate Recovery. You can read more about this new change here.
10| It's the Nursing Home's responsiblity to get me on Medicaid.
It is your responsibility to be sure you plan to pay for your Nursing Home expenses. If you find yourself or a loved one in a situation where long-term care is imminent, it is wise to be sure you seek the advice of a professional to be sure you have a plan in place right away. While many Nursing Homes process Medicaid applications as a courtesy for their residents, the responsibility of supplying the State Agency with the application, the required documentation, and the information ultimately falls on the resident and their families.