Medicaid Information for Long Term Care
by: Georgia Department of Human Resources, Division of Aging Services
MEDICAID INFORMATION FOR LONG TERM CARE
Prepared by:
Natalie Thomas, Esq.
State Legal Services Developer
Georgia Division of Aging Services
2 Peachtree Street, NW, Suite 9.398
Atlanta, Georgia 30303-3142
(404) 657-5328
Last Updated: January 2005
There are often many questions about eligibility for Medicaid and since the changes in the Federal Law in 1993 concerning what is allowed and what is not allowed under transfers of assets under Medicaid rules, the picture has become even more confusing at times.
This document will attempt to clarify and simplify some of those points. It is not to be taken as legal advice and it is not information that can be easily applied outside of the State of Georgia since state implementation of the Federal Law will differ from state to state. It should also not be viewed as an Estate Planning tool but will hopefully clarify the questions that one might want to ask of an attorney, an estate planning specialist or a Medicaid specialist with the state's Division of Family and Children Services Adult Medicaid Program.
The eligibility numbers in this document will change on at least an annual basis, some effective January 1st and some effective March or later of the year. Therefore, it is absolutely necessary that persons using this document check the last revision date to make sure that you have the latest edition.
For additional information about this document, contact the State Legal Services Developer at the Georgia Department of Human Resources Division of Aging Services at (404) 657-5328, the Georgia Senior Legal Hotline at (404) 657-9915 or 1-888-257-9519 or the Department of Family and Children Services office located in your county.
What is it people want to know?
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There are several questions that are normally asked when people are thinking about long term care and Medicaid. Generally those questions include:
• What does it take to become financially eligible for Medicaid?
• How much money and property can I have and still be eligible for Medicaid?
• Can I give away my money and property or some of it and still be eligible for Medicaid?
• Do I have to spend all of my money before I can become eligible for Medicaid?
• What will my spouse live on if I have to go into a nursing home on Medicaid?
• How will my burial be paid for if all of my money has to go to the nursing home?
• I promised to help send my grandchild to college, do the Medicaid rules prevent me from doing that?
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Some of these questions will be answered for you, some will just be addressed briefly and you will have to seek answers for your particular situation and fact pattern. Remember, this document is just for educational purposes and not for estate planning or legal advice.
Will this document tell me all about Medicaid?
No. There are a number of different types of Medicaid. This document will only discuss a few classes through which one might become eligible for Medicaid, which will pay for nursing home care. Because the same rules apply, this information can also be applied to persons who want to become eligible for Medicaid for home and community based programs such as the Community Care Services Program.
Is this the same as Medicare?
No. Medicaid should not be confused with Medicare. Medicare is the health insurance program funded and operated completely by the Federal Government which people receive because they are either 65 years old or older or because they have been disabled for 24 consecutive months or have a particular kind of kidney disease. Medicare is what you get from the Social Security Administration and one of the taxes you pay as you work throughout your career. Medicare operates under the same rules in every state.
What do you mean by "classes of Medicaid"?
Medicaid, a federal and state funded program administered at the state level, by the Georgia Department of Community Health has several different types of Medicaid that offer coverage for people for different reasons. There are types of Medicaid that cover children, pregnant women, the blind, the disabled, the aged and others who meet certain eligibility requirements. Each Medicaid program or class has its own set of rules and requirements. Programs offered in one state may not be offered in another state and if they are, they may operate under different rules.
What "classes" of Medicaid provide Nursing Home coverage?
• Nursing Home Medicaid,
• Spousal Impoverishment and,
• SSI Medicaid
are the three classes of Medicaid that will be dealt with in this document.
To keep from making this document extremely long and very confusing, it is best that the requirements for just these three classes be addressed here.
Other classes will not be covered here, except to mention the Adult Medically Needy (AMN) Program for those with income over the maximum amount, which allows them to spenddown the excess amount to the required levels. See below for Important Note on AMN.
What about transferring money and property, will that be discussed here too?
Yes. Since transferring money and property can have a direct impact on whether or not someone is eligible for Medicaid for long term care, that issue will be addressed in this document.
What does it take to be eligible for Medicaid that pays for Nursing Home care?
First, for an individual to be eligible for Medicaid, it is necessary to know whether that person is financially eligible for Medicaid through SSI (Supplemental Security Income), Nursing Home Medicaid or another class of Medicaid that might pay for nursing home care. The rules are different for each one and will be discussed later in this document.
Second, there is a level of care hurdle. In order for Medicaid to pay for a person to stay in a nursing home and receive care for as long as that care is medically necessary, a person first must meet the required "Level of Care". This means that the state has set certain medical requirements that a person through his or her doctor must prove have been met in order for that person to be eligible. Next, the person must already be a resident in a nursing home that is certified to accept Medicaid as payment and must have been there for at least thirty (30) days.
What is the level of care that must be met in order to be eligible for Medicaid to pay for your nursing home stay?
The person must have a physical and/or mental impairment, which requires continued nursing care, monitoring and supervision, under the direction of a licensed doctor. The person must be unable to provide this nursing care to himself or herself.
Simply put, the person must meet at least one requirement from column A and one requirement from either column B or C:
| A. Medical |
B. Mental |
C. Functional |
| Nutritional Status |
Memory Deficiencies |
Moving around is a problem |
| Skin care needed |
Trouble making decisions |
Needs help with feeding and actually setting up meals |
| Catheter Care |
Behavior problems |
Direct assistance is needed to help maintain continence |
| Physical, speech or other therapy needed |
Undetermined cognitive problems |
Communication deficiencies |
| Specialized nursing services needed to restore person to previous state of health |
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Personal hygiene, dressing require direct assistance |
| Vital signs need to be monitored |
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| Help needed managing medications |
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NOTE: These categories are being simply and generally stated and more detail on them must be obtained for a determination of eligibility.
What are the rules for Medicaid eligibility under SSI?
SSI or Supplemental Security Income is a federal entitlement program available from the Social Security Administration for persons who are either 65 years old or blind or otherwise disabled and under a certain income requirement. In Georgia, SSI entitles a beneficiary to a monthly check and Medicaid eligibility.
When an individual or a couple is in a nursing home or a long term care situation, these are the general income and resource rules that must be met in order to be eligible for SSI Medicaid to pay for that long term care:
2005 Maximum Income Limit:
$579.00 per month for an individual
$869.00 per month for a couple
(Think of income as money that comes into the household during the month)
Maximum Resource Limit:
$2,000 for an individual
$3,000 for a couple
(Think of resources as property of value that is owned for more than 1 month, such as houses, land, cars, savings accounts, IRAs, CDs)
What are the rules for Medicaid eligibility under Nursing Home Medicaid?
Maximum Income Limit:
$1, 737 per month for an individual
$3, 474 per month for a couple
Maximum Resource Limit:
$2,000 for an individual
$3,000 for a couple
The resource limits are really low, does that mean that I have to use up every penny that I have saved?
No, not necessarily. Some resources are included when eligibility is being determined, which means that the total value of those resources must fall within the resource limit stated above. Some resources are excluded when eligibility is being determined, which means that although they fit the definition of a resource, there is a special rule which allows you to own or possess that resource and it doesn't count against you when you're trying to become eligible for Medicaid.
The following chart will demonstrate the resources that count when eligibility is being determined as well as the resources that will be excluded from consideration when eligibility is being determined.
Note the differences in the treatment on some of the resources when the Medicaid is from SSI and when the Medicaid is Nursing Home Medicaid.
NOTE: Termination of Adult Medically Needy Spenddown Program (AMN) for Nursing Home Residents
This Program terminated for Nursing Home Residents effective 9/1/04. It enabled those whose income exceeded the Maximum Level to still be eligible for Medicaid.
In order for those persons whose income exceeds the Income Limit above to become eligible for Medicaid, they can create a "Miller Trust" for the excess income. For more information about a "Miller Trust" or to obtain a form, call the Georgia Senior Legal Hotline at 1-888-257-9519 or your local Area Agency on Aging for the number of your Elder Legal Assistance Program provider or contact a private attorney.
Medicaid Resources Chart
| Resources that count toward eligibility |
Resources that don't count toward eligibility |
| Cash; stocks; bonds; money market accounts; certificates of deposit |
The maximum resource limit for SSI Medicaid or Nursing Home Medicaid |
| Real property (land) (some exceptions will apply) |
The house you live in and all the land the house is on and any other buildings on that land as long as you state an intention to return home or if a dependent family member or spouse is still living in the home.
Other instances when real property can be excluded as a resource include the following:
• If the property is business property or is income producing (rental property is excluded as a resource but the rent is treated as income)
• If the property is used to produce goods for home use or home consumption except that only up to $6,000 of equity value is excluded and the property must be currently in use or about to resume being in use within the next 12 months |
| An IRA which belongs to the spouse of a Nursing Home Medicaid recipient (for the purposes of the Spousal Impoverishment program) |
IRAs from which payments are being made to the Medicaid recipient. |
| Burial accounts that are not itemized and not completely paid for and for the benefit of persons outside the immediate family and/or related only to the spouse |
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| Household goods/personal property over the recipient declared value of $2,000 for SSI Medicaid recipients |
All household goods/personal property for Nursing Home Medicaid recipients |
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Durable medical equipment |
How is a person supposed to pay for burials and funerals if they can't save any money?
There is a way of setting aside some money for burial.
Some resources are treated so differently for SSI than they are for Nursing Home Medicaid that it is necessary to provide additional information about them. Those resources include burial contracts, burial accounts, property other than the homeplace, automobiles and life insurance policies.
See the two tables that follow.
Treatment of Resources Under SSI Rules
| Resource |
Rules |
| Automobile |
The value of one car up to $4,500 is excluded from consideration of eligibility. If one of the following is true, then the entire value is excluded regardless of the amount:
• The automobile is needed for employment transportation
• The automobile is needed for transportation back and forth for medical treatment
• The automobile is needed for handicapped accessibility
• The automobile is necessary for the particular climate, terrain or for the performance of activities of daily living |
| Life insurance |
Policies with a face value of up to $1,500 are excluded
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| Burial contracts |
Burial contracts or pre-need contracts which one has with a funeral home to take care of burial arrangements of self, spouse or immediate family members are excluded from consideration of eligibility if the following are true:
• It has been paid in full
• It is itemized
• It is owned by the Medicaid recipient and is for the benefit of him/her or the spouse or an immediate family member (spouse; minor/adult natural, adopted or step children and their spouses; parents and their spouses; and siblings and their spouses) |
| Burial accounts |
Recipients are allowed to have up to $1,500 in a burial account. If one does have a burial account, the total face value of the life insurance policies must be subtracted from that amount as well as any non burial space portions of an irrevocable burial trust or contract |
Treatment of Resources Under Nursing Home Medicaid Rules
| Resource |
Rule |
| Automobile |
All automobiles are excluded regardless of how many there are and what they are used for. (automobiles are defined as any vehicle used for transportation even if it is broken down and includes cars, trucks, snowmobiles, animal drawn vehicles and animals) |
| Life insurance |
The cash value of all life insurance policies having a face value of $5,000 or less are excluded. |
| Burial contracts |
The entire refund value of any burial contract is excluded if the following are true:
• It's for the benefit of the Medicaid recipient, spouse or immediate family
• It has been paid in full
• It is itemized
Any non-itemizes burial contract designated for someone other than the Medicaid recipient, the spouse or someone who's income/resources is "deemed" to the Medicaid recipient will be counted as a resource. |
Burial accounts
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Up to $5,000 for the Nursing Home Medicaid recipient and up to $5,000 for the spouse of the Nursing Home Medicaid recipient. |
What if I have a spouse, how is my spouse supposed to live if all the income and savings has to be spent because I'm going on Medicaid to pay for my nursing home care?
There is a program which is considered a companion to the Nursing Home Medicaid program. It is called the Spousal Impoverishment Program. This program is available only to couples when one is on Medicaid and the other continues to live in the community without the assistance of Medicaid.
The benefits of this program keep the community spouse (the spouse not in the nursing home or Medicaid funded long term care facility/program) from being completely without resources and income to maintain living expenses. In order to be eligible under the spousal impoverishment program, the following is allowed:
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The community spouse keeps his/her own income and the income of the nursing home Medicaid resident up to a total of $2, 377.50 per month, minus the nursing home resident's personal need allowance of $30.00 in the nursing home and $90.00 if the income is Veterans Benefits. Any amount over $2, 377.50 must be used to pay the Medicaid spouse's long-term care expenses. (There are some exceptions for excess medical expense not paid for by Medicaid.)
The community spouse may keep up to $95,100.00 in resources.
The community spouse may have his/her own burial contract and burial account of up to $5,000 in addition to the $95,100.00 resource limit.
The nursing home Medicaid spouse may still have up to $2,000 in resources.
The nursing home Medicaid spouse may still have his/her own burial contract and burial account.
The community spouse may not only still continue to live in the house but once enrolled in the spousal impoverishment program, the house may legally be transferred into the name of the community spouse without the nursing home Medicaid spouse being penalized for the transfer.
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What if it doesn't look like I'm eligible under any of these programs listed here, does that mean that I can't qualify for Medicaid?
No, not necessarily. It just means that this document probably doesn't address the class of Medicaid for which you might be eligible. If you are interested in applying for Medicaid, you should contact the Department of Family and Children Services Office in your county and let a Medicaid worker determine whether or not there is a class of Medicaid for which you might be eligible.
I don't have a spouse who can use my resources and I don't want to have to spend all of my money on long-term care because I have children and grandchildren who could use my money more. Why can't I just put in my Will that all of my money is supposed to go to them?
While you can put that designation in your Will, remember that your Last Will and Testament has absolutely no affect on anything while you are alive. It is a legal document that states how you want your property distributed but it has no authority until you are dead.
If that's true, then I'll just give everything I have away so there won't be anything left to have to go to the nursing home and just let Medicaid take care of it. Who'll know the difference?
Simply giving away your money and your property so that you can become eligible for Medicaid to pay for your long-term care expense can be a problem. Federal law requires states to impose a penalty against people who apply for Medicaid within 36 months after they have transferred some or all of their money and/or property for the purpose of becoming eligible for Medicaid.
NOTE: A penalty will not be imposed if the assets that were transferred are returned to the Medicaid recipient.
What is the penalty?
The penalty is disqualification from receiving Medicaid for as many months as it takes for you to use the amount of money or value of property that you transferred. The amount that you transfer is divided by the average Georgia private pay nursing home rate to come up with the number of months of your penalty.
Example: $10,000 transferred ÷ $3,860 (the avg. Georgia nursing home rate since 4/2004) = 2.59 months.
The penalty would be 2 months (the number is rounded down and no partial months are applied)
Official policy states that each transfer will be considered a separate one and a penalty will apply to each transfer, although some attorneys note that separate transfers made to different people within the same month have been added together to be treated as one transfer. Transferring assets for reasons other than becoming eligible for Medicaid is allowable but make sure that you receive sound advice before doing so.
When does the penalty take effect?
The penalty begins to run the month the assets were transferred. Penalties are applied consecutively (one after the other) instead of being applied concurrently (together).
How long after I transfer money or property will I have to wait before applying for Medicaid?
The official look back period is 36 months or 3 years unless the transfer is into a Trust, then the look back period is 60 months or 5 years.
The look back period begins:
- the date the individual is actually in the facility,
- when the individual is receiving nursing facility services in another institution or,
- when the individual is receiving services at home under community care and has applied for Medicaid.
What if my money is in a joint account or my property is in my name and someone else's and that person takes the money or property without my permission or knowledge?
Adding another person or persons to an asset such as a bank account, certificate of deposit or a deed to real property (land) is not a transfer in an of itself. However, if the person who is on the account or deed with you takes money from the account or transfers the property for less than fair market value, the penalty applies even in a joint tenant or tenants in common situation.
So is there no way that I can provide for my family who depends on me?
Actually, yes there are some ways resources can be properly used to provide for dependents. Federal law provides some exceptions to transfer penalties that allow individuals to legally transfer property and money without being penalized.
See the acceptable transfers in the table that follows:
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ACCEPTABLE TRANSFERS TO AVOID PENALTIES
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MEDICAID ESTATE RECOVERY
What Is Estate Recovery?
The program seeks to recovery from the estate of the person who received long-term care Medicaid benefits, dollars to reimburse the state for what the state spent on the recipient.
When Did This Change Occur?
The Georgia General Assembly as of 4/2004 passed an appropriations bill requiring the implementation of Medicaid Estate Recovery by the Department of Community Health (DCH), Georgia's Medicaid agency. This was a change in the Federal Law since 1993, but Georgia had not implemented the program until now.
Who Is Affected By Estate Recovery?
Affected by the recovery are those Medicaid recipients members who at the time of death were 55 or older AND who received Medicaid payment as:
a. A resident of a nursing facility;
b. A resident of an intermediate care facility for the mentally retarded; or
c. A recipient of home and community-based services (this includesMedicaid waiver programs such as the Community Care Services Program).
What Is Meant By Recovery?
The state will place a lien on the property that it identifies as eligible to be used to reimburse the state for the dollars spent on the Medicaid recipient. That property may include the house and any other property owned by the Medicaid recipient at the time of his or her death or in which they held an interest. The Rules allow for certain exemptions such as estates valued at $25,000 or less and excess funds from burial trusts, promissory notes, cash and personal property. But it includes real property that passes by joint tenancy, right of survivorship, reserved life estate, trust, annuity, and any other arrangement.
When Does Recovery Take Place?
Federal law does not allow recovery to begin as long as the Medicaid recipient is alive, nor during the life of the recipient's spouse or certain dependents of the Medicaid recipient.
Are There Any Exceptions?
The State may not enforce a lien under any of the following circumstances:
- When the Medicaid recipient's spouse is still alive whether or not the spouse is living in the home
- When the recipient's child (if under the age of 21) is alive, whether or not the child is living in the home
- While the recipient's child is alive, if that child is blind or disabled, regardless of whether or not that child is living in the home
- While an adult child of the recipient is living in the home, if that child lived in the home for at least two years prior to the recipient's admission to the nursing home and provided care that kept the recipient from entering the nursing home
- While the brother or sister is living in the home, if he or she lived there at least two years prior to the recipient's admission to the nursing home
Are There Any Provisions for a Waiver?
The Rules explain under what conditions a Hardship Waiver can be applied for and granted.
Some grounds for granting a waiver included:
- The asset to be recovered is an income producing farm of one or more of the heirs and the annual gross income is limited to $25,000 or less, or
- Recovery of assets would result in the applicant becoming eligible for governmental public assistance based on need and/or medical assistance programs.
WARNINGS!!
This is not all there is to Medicaid for long term care.
There are other things that may be considered.
Every person's situation could be different from another person's situation.
What works for your neighbor may not work for you.
Even if it looks like you may be eligible because of what you read in this document, for other reasons, you may not be eligible.
Even if it looks like you may not be eligible because of what you read in this document, for other reasons, you may be eligible.
For legal advice specifically tailored to your situation, speak with an attorney knowledgeable about this subject.
For other information about how the Division of Family and Children Services applies the rules of Medicaid, call the county office.
Natalie Thomas, Esq.
State Legal Services Developer
Georgia Division of Aging Services
2 Peachtree Street, NW, Suite 9.398
Atlanta, Georgia 30303-3142
(404) 657-5328
Last Updated: January 2005
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