Georgia Medicaid Long Term Care Eligibility
Georgia Long Term Care
Georgia is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application. In order for persons whose income exceeds the Maximum Income Limit to become eligible for Medicaid long-term care services, they can create a Qualified Income Trust, commonly known as a “Miller Trust,” for the excess income. To become eligible, the state must be named beneficiary on the Miller Trust.
Medicaid long term care in Georgia allows seniors to live in whichever setting is most fitting for their situation. This could be a nursing home, the recipient’s own home, or a caregiver’s home. To be eligible, applicants must meet both income and asset limits, which may be different than other Medicaid programs they are currently enrolled in. Beyond economic factors, other deciding elements include functional status, age (in the Independent Care Waiver Program), citizenship, and Georgia residency status. Waiver recipients must qualify for the level of care given in a nursing facility or similar institutional setting. Listed below are the types of services covered in Georgia.
Independent Care Waiver Program (ICWP)
ICWP offers services to people with specific physical disabilities, including people with traumatic brain injuries. Generally, this program is for people who are between the ages of 21-64 and are severely disabled. The services include personal support, emergency response, home health, counseling, home modifications (fall proofing the home), and affordable access to medical equipment or supplies.
Community Care Services Program (CCSP)
The CCSP waiver exists to give home and community based services to the elderly and/or impaired or disabled. The programs include case management, personal care, adult day care, alternative living, delivered meals, home health, emergency response service, and respite care.
Service Options Using Resources in a Community Environment (SOURCE)
SOURCE serves the elderly, disabled, and frail who are eligible for Supplemental Security Income/Medicaid. This program uses the patient’s primary care physician on the case management team. As well as offering monitoring and assistance with functional tasks, SOURCE also offers assisted living services, personal care, delivered meals, home health, emergency response, and around the clock medical access to a case manager and physician.
Money Follows the Person (MFP)
MFP began as a five-year grant aiming towards shifting people out of institutional care and back into their homes. It allows people who need an institutional level of care to receive that care in the comfort of their own homes. Eligible participants are those who have been inpatients in a long term care facility for at least 90 consecutive days and are covered by Medicaid. Members must continue to need institutional levels of care after transitioning back into the community.
Home Health Services
Home health includes home health aides, physical, speech and occupational therapy services, and skilled nursing. Services are provided in the member’s home and are based upon physician orders. Usually, there is an annual limit on the number of home health visits that can be reimbursed since this type of care is meant to be short term. Home health requires that the patient be physically unable to leave the home to access the medical care they need.
This includes end of life medical care, palliative care, and other services for terminally ill people and their families. Hospice offers nursing, medical social care, counseling, medications, medical equipment, and aide. The care can be given in a patient’s home or in a licensed facility.
- Pre-Admission Screening and Resident Review (PASRR) – PASRR screening is completed for all nursing home residents prior to admission or for any status change to determine if there are indicators of mental illness and/or mental retardation. This screening is intended to assess whether an individual is appropriate for nursing facility placement. The Level I screening is the first step to determine if there are positive indicators for mental health diagnosis or suspected diagnosis. Those who do not meet the Level I screening are referred for a Level II assessment. The Level II assessment determines if a nursing facility level of care is appropriate and if the individual requires additional mental health services during their nursing facility residency.
- A person hoping to receive long term care must meet at least one requirement from column A and one requirement from either column B or C:
Applicants have a monthly income limit of $2,199 with a resource limit of $2,000. A couple, if both members need long term care, can have an income limit of $4,326 with a resource limit of $3,000. If one spouse remains without long term care then the resource and income amounts go up considerably.
Amount of assets community spouse may retain: The maximum value of assets a community spouse can retain for self-support without disqualifying the nursing home spouse from eligibility is $119,240. If the community spouse’s assets do not equal a minimum of $117,240, he/she may be able to keep some of the nursing home spouse’s resources until the maximum is met.
Community spouse impoverishment protection: If the community spouse’s income does not equal at least $2,980 per month, he/she may keep some of the institutionalized spouse’s income in order to meet the limit.
Georgia Classifications of Income:
- Wages, Social Security benefits, pensions, veteran’s benefits
Georgia Classifications of Assets:
- Bank Accounts, stocks, bonds, annuities, trusts, property insurance, life insurance, cars (beyond one), homes if no one is living in it, non-home property, IRAs if there is an option to withdraw the fund as lump sum (even if the IRA is ineligible for periodic payments), annuities providing monthly payments. If Georgia has paid for your nursing home care for more than six months, and there is no expectation to return home, with no spouse or disabled child living in the home, Georgia can place a lien on the home.
Georgia Excluded Assets:
- Principal residence regardless of value (if someone is living in it), household items, jewelry, burial plots, burial funds and arrangements (up to $10,000), one car, insurance policies with face value up to $1,500, life insurance policies with cash surrender of less than $10,000 may be excluded, and leased vehicles.
Georgia allows people seeking long term care to form a public-private partnership between long term care insurance providers and the state offered long term Medicaid care. It allows individuals to access care without depleting their assets or spending down. For every dollar that a partnership insurance company pays in benefits, a dollar of assets can be disregarded from the long term care Medicaid asset limit. A Partnership policy is ideal for someone who will not be able to afford the high cost of long-term care, but who can afford the reasonable cost of long-term care insurance.
For more information about a “Miller Trust” or to obtain assistance with creating a “Miller Trust”, call the Georgia Senior Legal Hotline at 1-888-257-9519 or your local Area Agency on Aging at 1-866-55AGING for the number of your Elderly Legal Assistance Program provider or contact a private attorney.
- Georgia Department of Community Health: http://dch.georgia.gov/
- Long Term Care Ombudsman: 888-454-5826
- Department of Veterans Assistance: 1-800-829-4833
- Long Term Care Partnership Insurers
- More information: http://dhs.georgia.gov/sites/aging.dhs.georgia.gov/files/imported/DHR-DAS/DHR-DAS_Publications/ELAP-%20Medicaid%20LTC%202012_final-2.pdf