Medicaid Planning in Georgia

There are basically five ways that you can pay for the cost of a nursing home:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

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.

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).

No, this is simply not true and even though some families do spend virtually all of their savings on nursing home care, Medicaid does not require it. There are a number of strategies that can be used to protect your family’s financial security. In addition, there are also many assets that are considered exempt for Medicaid eligibility purposes.

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.

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.

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.

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.

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!

  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.

In most cases your home is an exempt asset for eligibility purposes. You can own your home and receive Medicaid benefits! However, the State of Georgia has a Medicaid Estate Recovery Program. Fortunately, there are ways to protect your property and minimize your exposure to Estate Recovery.

The law has severe penalties for people who simply give away their assets to create Medicaid eligibility. There is a look-back period of five years. Gifting may be possible; however, it is critically important that you have the advice of an elder law attorney well versed in Medicaid rules.

Good News! 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.

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.

Relax, your husband can transfer the home to you and remove it from consideration of estate recovery.

In 2019, if your income exceeds $2,313 per month, a Qualified Income Trust also called a Miller Trust must be established in order to qualify for Medicaid. Once that QIT is in place and properly funded, you may proceed with a Medicaid application.

Yes, all of the Medicaid recipient’s income less deductions for medical insurance will go to the nursing home where they reside. As the community spouse, you are eligible for the Monthly Maintenance Needs Allowance (MMNA). In 2019 the maximum allowance is $3,160.50. For example, if your income is $1200 per month you will receive income diversion of $1,960.50 per month to reach the MMNA. If your income is over $3,160.50, you will receive no income diversion. Keep in mind that the Community Spouse is allowed to maintain up to $126,420 of the couple’s countable resources. It is not necessary to deplete your life savings down to $2,000.00 in order for your spouse to become eligible for Medicaid.

No, in the State of Georgia, Medicaid can only be utilized for a skilled nursing facility. Medicaid will pay for some smaller personal care homes – often facilities with 3-5 beds.  The Coalition of Advocates for Georgia’s Elderly and the Georgia Council on Aging have been lobbying our legislators for Medicaid Funded Assisted Living; you can read more here.