Have You Lost Your Nursing Home Medically Needy Medicaid?
by: Georgia Legal Services Program
Nursing Home Residents:
Did you get a notice that you are no longer eligible for Nursing Home Medically Needy Medicaid?
If so, you may be able to protect your Medicaid.
The notice you received from the Department of Human Resources told you that the state would no longer provide you with Nursing Home Medically Needy Medicaid as of July 1, 2004. Because this program is ending, your income is higher than the state will allow under the regular nursing home Medicaid program after June 30, 2004.
However, there is a way you may be able to protect your Medicaid.
First, you should file an appeal. Ask for a Fair Hearing from your local Division of Family and Children Services (DFCS) office. Use the forms under the "Court Forms / Legal Forms" tab of this section of the LegalAid-GA.org web site.
Second, you may be able to set up a Medicaid Irrevocable Qualified Income Trust. (This is sometimes called a "Miller Trust.") If you put some of your Social Security and/or pension check into this special trust each month, it will not count against you for Medicaid eligibility. If you do this, you should be able to continue to pay for your care as you do now and still get Medicaid.
How a Medicaid Irrevocable Qualified Income Trust is usually established:
1. The resident fills out and signs an Irrevocable Medicaid Qualified Income Trust form. This authorizes a Trust to be created for the resident's benefit only. You may get a copy of the form from your Georgia Legal Services or Atlanta Legal Aid Office. You can also find the form in the "Court Forms / Legal Forms" tab of this section of the LegalAid-GA.org web site.
2. The resident appoints a person who is willing to be the trustee, and puts that person's name on the Trust form. The trustee will transfer some of the resident's income each month to the Trust account. The trustee will be the only person who can write checks on the Trust account to pay the nursing home and to pay for other items the resident may be paying for now such as a spousal allowance. The trustee will report on the status of the Trust account to the Department of Community Health.
3. The resident usually opens a bank account for the "(Resident's Name) Irrevocable Medicaid Qualified Income Trust." If the resident cannot do this, a person with a Power of Attorney usually can do it.
4. The trustee then provides a copy of the Trust document to the county Department of Family and Children's Services. DFCS can tell the trustee how much of the resident's income to put in the Trust account each month to help her or him keep Medicaid and how much to pay for other things.
The amount of income the trustee must put into the Trust account depends on how much higher the resident's income is than the current Medicaid cap for nursing home residents. In 2004, the cap is $1,692 a month, so at least any amount over that would be put in the Trust account. The state will use the total amount of the income, including the amount in the Trust account, to decide how much the resident must pay the nursing home.
The Trust must be irrevocable. Once it is set up, it cannot be canceled. However, if the resident decides later to leave the nursing home, she or he may keep the income and stop putting it into the Trust. Any income left from the Trust after the resident's death must go to the State as reimbursement for Medicaid payments.
Setting up this Trust now could protect the resident's Medicaid. You may want to get a lawyer to help you set up the Trust. You may choose to do it yourself or with help from others. For more information, contact:
Georgia Legal Services Program at 1- (800) 498-9469 or Atlanta Legal Aid at (404) 524-5811
Georgia Legal Services Program
June 2004
Document Last Revised by: Vicky Kimbrell, Linda Lowe and Susan Reif
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