When an individual has income and assets that exceed the Medicaid threshold there are options available to avoid a spend down or a Medicaid denial. A Certified Elder Law Attorney can help you implement a plan that allows an individual to qualify for Georgia Nursing Home Medicaid, and preserving a substantial portion of their assets.
Income and Asset Requirements
If one spouse needs Medicaid for a skilled nursing facility, families are afraid that the assets they have accumulated over a lifetime will quickly be depleted due to the high cost of care. Working with a Certified Elder Law Attorney at HECL, a spouse can confidently preserve all of their hard-earned savings while still receiving the Medicaid benefit for the spouse who needs long-term care.
Income and Asset Requirements – Good News for Married Couples
If your spouse is in a nursing home, Medicaid does NOT consider your income in determining eligibility. Even if your income is $1000 a month or even $10,000 per month – it doesn’t matter! In fact, if your income is below $3,259.50 you can receive some of your unwell spouse’s income too!
I’ve got more good news, you can keep $130,380 of your assets. If you have assets above and beyond that, Hurley Elder Care Law can devise a plan to save all of your hard-earned savings. Click here for a discussion on countable and exempt assets as well as income diversion. In Georgia, the community spouse is allowed to keep all countable assets up to $130,380 (as of 2021). This is called the Community Spouse Resource Allowance (CSRA). Each state also establishes a monthly income floor for the at‐home spouse. This is called the Community Spouse Maintenance Needs Standard (CSMNS). This permits the community spouse to keep a minimum monthly income of up to $3,259.50 (as of 2021).
Case Study | Medicaid Planning for Married People
Ralph and Alice were high school sweethearts who lived in Marietta their entire adult lives. Two weeks ago Ralph and Alice celebrated their 51st anniversary. Yesterday Ralph, who has Alzheimer’s disease, wandered away from home. Hours later he was found sitting on a street curb, talking incoherently. He was taken to a hospital where he is being treated for dehydration. The family doctor tells Alice she needs to place Ralph in a nursing home. They both grew up during the Depression and have always tried to save something each month. Their assets, totaling $182,000 not including their house, are as follows:
- Savings Account $30,000
- CDs $90,000 Money
- Market Account $50,000
- Checking Account $12,000
- Residence (no mortgage) $80,000
Ralph gets Social Security and pension checks totaling $1500 each month; Alice’s Social Security check is $450. If Alice and Ralph have to pay the private pay rate to the nursing home, their entire life savings will be gone in less than two years! What’s more, Alice is afraid she won’t be able to pay her monthly bills, because a neighbor told her that the nursing home will be entitled to all of Ralph’s Social Security and pension checks.
There is good news for Alice. It’s possible she will get to keep her income, most of his income and most of their assets and still have the state Medicaid program pay Ralph’s nursing home costs. While the process may take a little while, the end result will be worth it.
To apply for Medicaid, she will have to go through the Georgia Department of Family and Children Services (DFCS). If she does things strictly according to the way DFCS tells her, she will only be able to keep her home and $130,380 of their assets plus she will be entitled to a minimum monthly income to pay her expenses.
But the results can actually be much better than the traditional spend‐down, which everyone talks about. Alice might be able to turn the spend‐down amount of roughly $60,000 into an income stream that will increase her income and meet the Medicaid spend‐down right away. In other words, if handled properly, Ralph might be eligible for Medicaid from the first month he goes into the nursing home.
Please note that this will not work in every case. That is why it is important to have an elder law attorney guide you through the system and the Medicaid process to find the strategies that will be most beneficial in your situation.
Alice will have to get advice from someone who knows how to navigate the system, but with proper advice she may be able to keep most of what she and Ralph have worked so hard for. This is possible because the law does not intend to impoverish one spouse because the other spouse needs care in a nursing home. This is certainly an example where knowledge of the rules and how to apply them can be used to resolve Ralph and Alice’s dilemma.
Of course, proper Medicaid planning differs according to the relevant facts and circumstances of each situation as well as the state law.
Atlanta’s Top 10 Medicaid Myths
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.
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.
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.
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 matter 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.
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.
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.
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.
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.
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.
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.
Medicaid has truly become the long-term care insurance of the middle class. As we live longer and as care costs continue to rise, more and more families will look to Medicaid to pay the cost of Nursing Home care. Consult a Certified Elder Law Attorney (CELA) to determine if Medicaid qualification is an option for your loved one.
Have questions about how Medicaid could work for you?
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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! When dealing with a Medicaid denial knowledge is power.