Medicaid for Individuals

Medicaid for Individuals

When an individual has income and assets that exceed the Medicaid threshold, The Certified Elder Law Attorneys (CELA) at Hurley Elder Care Law Elder Law 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.

Income and Asset Requirements

Eligibility for nursing home Medicaid is based on both your income and assets. In 2019 the income cap for Medicaid eligibility is $2,313 per month. If your monthly income exceeds $2,313 you can still qualify for Medicaid by utilizing a Qualified Income Trust (also know as a Miller trust. Contact us to learn more about the Miller Trust. For a single person to qualify for Medicaid their total assets must be less than $2,000. Medicaid does consider certain assets “exempt.” (For a discussion on exempt and countable assets, please click here).

Case Study

Mrs. Johnson is a 91 year old widow who fell and broke her hip. After surgery and rehabilitation, she has limited mobility requiring skilled nursing care. She has a savings and checking account with a combined balance of $92k and a small IRA of $32k. Her monthly pension and social security combined are $1723 per month Working with Hurley Elder Care Law her family will be able to preserve between 50 -65% of her assets.

Medicaid FAQ

Will I have to spend down all my money before I can receive Medicaid?
      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.  
Is Medicaid is going to take my home?
  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.  
Can I transfer all of my cash and assets right away to be sure I am eligible for Medicaid?
  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 a orney well versed in Medicaid rules.  
Isn’t Medicaid is only for extremely poor people?
  No! As life expectancies and long-term care costs continue to rise, the challenge quickly becomes how to pay for these services. Many people cannot afford to pay $5,000–9,000 per month or more 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. 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 I receive Medicaid assistance, will I be able to put money aside to pay for my final expenses?
  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.  
Won’t the Nursing Home apply for Medicaid for me and make sure that my insurance covers everything?
  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 Denials

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. For more information on Medicaid Eligibility please click here.

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 $126,420 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 $6,707 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 $2,313 in 2019), 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.


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?

Contact us now and someone in our office will respond the following business day.