Medicaid Planning

Medicaid Planning in Georgia

Do You Need Help Paying for Nursing Home Care?

When a loved one requires skilled nursing level care, many families face the difficult question on how to pay for the care required. Nursing homes in Georgia cost on average between $7,500 and $9,500 per month and some facilities are over $10,000 per month! This is hard to sustain for even the most diligent savers! Despite many years of working and saving, families are concerned that there simply won’t be enough money to cover the cost of care. Georgia rules restrict who may qualify for Medicaid’s nursing home benefit. When an individual has income and assets that exceed the Medicaid threshold, we have devised a series of strategies for these circumstances. This allows an individual to qualify for Georgia Nursing Home Medicaid while preserving a substantive amount of their assets.

Is your loved one single, widowed or divorced?

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Are you looking for help for a married couple where one or both spouses are entering a nursing home?

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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?

A Miller Trust is an Irrevocable Qualified Income Trust. The Miller Trust specifically allows people who cannot afford nursing home care, but who have a monthly income that exceeds the Medicaid income cap, to be eligible for Medicaid coverage. The trustee is typically a family member, and the Medicaid applicant is the trust beneficiary. The Miller Trust serves no purpose other than being a tool for Medicaid qualification. We call it the extra “hoop” that has to be jumped through.

What are the requirements of a Miller Trust?

As an irrevocable trust, it cannot be changed or cancelled. The trust must also have the following features: • The trust must be set up in Georgia no earlier than the first month that an applicant seeks to qualify for Medicaid. • The only deposits into the trust must be the applicant’s income (such as Social Security, pension, annuity payments and interest income). • To receive deposits and make payments, the trust must have its own checking account (with no fees). • The trust cannot hold any assets, such as a house or other investments. • Any funds remaining in the trust at the beneficiary’s death, under the terms of the trust, must be used to reimburse Georgia Medicaid for benefits received by the beneficiary.

How does the Miller Trust Account receive income?

The applicant receives income each month as usual into her regular checking account. At a minimum, the Medicaid applicant’s income in excess of the income cap ($2,382 in 2021) must be transferred into the Miller Trust account each month by check or automatic transfer. Some trustees elect to deposit all of the Medicaid applicant’s income into the trust account each month. Once funds are transferred into the trust account, they are spent in the four ways described below.

How can money in the Miller Trust account be spent?

Only four types of payments may be made from the trust: • The Medicaid applicant’s personal needs allowance of $70 per month. • The spousal diversion amount payable to an applicant’s spouse who does not live in the nursing home. • Medical expenses incurred by the applicant that are not paid by a third party, such as Medicare or other health insurance premium(s). • Any remaining funds each month are paid to the nursing home as the “patient liability,” the applicant’s contribution toward the cost of care after Medicaid’s payment to the nursing home. Once the above monthly payments are made from the trust, the balance in the account should be zero ($0) until the following month when the applicant’s income is again deposited into the trust.

Is your loved one a Medicaid applicant or recipient that has been denied coverage?

Receiving a denial after enduring the long and tedious Medicaid Application process can be scary and frustrating. Depending on the situation, there are many different strategies for overturning an initial denial. Our attorneys will review your specific situation and can not only assist with handling the appeal but may also be able to protect your original application date. Timing is of the essence in this situation so don’t delay. Contact us so that we can review your specific situation and find ways we can help!

Will I Lose My Home?

Many people who apply for Medicaid benefits to pay for nursing home costs ask this question. For many, the home constitutes much or most of their life savings. Often, it is all the couple has to pass on to their children. Under the Medicaid regulations, the home is an exempt asset (so long as the equity value is less than $585,000). This means its value is not taken into account when calculating eligibility for Medicaid benefits. But in 1993, Congress passed a little‐debated law that affects hundreds of thousands of families with a spouse or elderly parent in a nursing home. That law requires states to try to recover the value of Medicaid payments made on behalf of nursing home residents. Estate Recovery does not take place until the recipient of the benefits dies (or until both spouses are deceased if it is a married couple). Then, federal law requires that states attempt to recover benefits paid from the recipient’s probate estate and in some cases non‐ probate estate. Generally, the probate estate consists of assets that the deceased owned in his or her name alone without beneficiary designation. The non‐probate assets include assets owned jointly or payable to a beneficiary. About two‐thirds of the nation’s nursing home residents have their costs paid in part by Medicaid. Obviously, the Estate Recovery law affects many families. The asset most frequently caught in the Estate Recovery web is the home of the Medicaid recipient. A nursing home resident can often own a home and receive Medicaid benefits without having to sell the home. But upon death, if the home is part of the probate or non‐probate estate, the state may place a lien on the property in the amount necessary to reimburse the state for the Medicaid payments that were made. The state of Georgia has a Medicaid Estate Recovery Pro‐ gram. Fortunately, there are ways to protect your property in Georgia or to at least minimize your exposure to Estate Recovery. Since Medicaid rules are constantly changing, you will need assistance from an elder law attorney about these rules. Contact us to discuss your specific situation so that we can find ways to help.

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.