Answers to some of the most Frequently Asked Questions about Georgia's Nursing Home Medicaid program.
What is the difference between Medicare and Medicaid?
Medicare is a federal health insurance program for people who are 65 years or older or are disabled. You qualify for Medicare based on the work history of you or your spouse. Medicare eligibility is not based on financial need. Medicaid eligibility is based on financial need and other requirements.
If I need long term care, won't Medicare pay for it?
Unfortunately, no. Medicare only provides very limited long term care coverage, regardless of whether that care is provided at home, in an assisted living facility, or in a nursing home. In general, Medicare will only pay if you require "skilled" nursing or therapy provided by a licensed professional. Medicare will not pay for "custodial" care such as bathing, dressing, and preparing meals. Medicare also limits the number of days of skilled nursing home care it will pay for. Unlike Medicare, Medicaid does pay for non-skilled nursing home care and does not limit the number of days of care you can receive.
What kind of long term care does Medicaid pay for?
In Georgia, Medicaid most commonly pays for long term care in a Nursing Home setting through the Nursing Home Medicaid program. A very limited amount of funding is available for long term home care through Medicaid's Community Care Services Program (CCSP), but there are typically long waiting lists for CCSP.
How can I qualify for Medicaid?
In Georgia, in order to qualify for Medicaid long term care benefits, you must be blind, disabled, or 65 years or older and meet certain other eligibility requirements. You must also meet Medicaid's financial eligibility requirements.
What are Nursing Home Medicaid's 2015 financial eligibility requirements for a single applicant?
Single Applicants: Your gross income must be less than your nursing home costs. You can't have more than $2000 in countable assets, not including your home (as long as the equity value is less than $523,000) and one car. Medicaid will allow you to keep $50 per month of your income as a Personal Needs Allowance. You can also use your monthly income to reimburse yourself for certain unreimbursed medical expenses that have been approved by Medicaid. If you have any gross monthly income left over after making these payments, you will be required to pay it to your Nursing Home as a contribution to your cost of care.
What are Nursing Home Medicaid's financial eligibility requirements for a married applicant?
Married Applicants: Your gross income must be less than your nursing home costs. If you are married and your spouse is not in a Nursing Home, your spouse can keep $119,220 in countable assets, not counting your home and one car. If your spouse's gross income is less than $2,980 per month, you can divert to your spouse each month as much of your gross monthly income as is needed to bring your spouse's gross monthly income up to $2,980 per month, as long as your spouse is not also receiving Nursing Home Medicaid. Medicaid will allow you to keep $50 per month of your income as a Personal Needs Allowance. You can also use your monthly income to reimburse yourself or your spouse for certain unreimbursed medical expenses that have been approved by Medicaid. If you have any gross monthly income left over after making these payments, you will be required to pay it to your Nursing Home as a contribution to your cost of care.
What if my monthly income is more than the Medicaid Income Cap?
The Georgia Income Cap for 2015 is $2,199. If your gross monthly income is greater than that but not enough to pay for all of your Nursing Home Costs, you can qualify for Medicaid by setting up a Qualified Income Trust ("QIT"). Each month, your income will be deposited into the QIT. Each month, the QIT will pay you your $50 Personal Needs Allowance, pay for any unreimbursed medical expenses previously approved by Medicaid, and divert to your spouse any income needed to bring your spouse's gross monthly income up to $2,980 per month. Any remaining monthly income will be paid to the Nursing Home.
Can I transfer assets to my children in order to meet Medicaid's financial eligibility requirements?
The Nursing Home Medicaid rules generally prohibit applicants from giving away assets during the 5-year period preceding the date of their Medicaid application. The Medicaid rules do allow applicants to protect some assets, however, as long as the Medicaid rules are followed.
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