GEORGIA MEDICAID ELIGIBILITY OVERVIEW

The Georgia Medicaid program is administered by the Department of Community Health, Division of Medical Assistance. The Medicaid program is funded by the federal and state governments. States administer the Medicaid program using federal regulations and guideline. Medicaid is available only to certain low-income individuals and families who fit into an eligibility group that is recognized by federal and state law.

CATEGORIAL RELATIONSHIP

Many groups of people are covered by Medicaid. Even within these groups, certain requirements must be met. Every individual must be included in one of the following Medicaid categories:

• Family: Must be a child under age 21 or pregnant,
• Age: 65 years of age or older, or
• Blind: Under age 65 and visually impaired, or
• Disabled: Under age 65 and physically or mentally impaired.

BASIC ELIGIBILTY

Every individual must meet all the following basic eligibility criteria:

• Must be a resident of Georgia.
• Must be a U.S. Citizen or a qualified alien.
• Must have income and resources below the prescribed limits.
• Must agree to assign to the State all rights to medical support and third-party support payments (hospital and medical benefits).
• Must apply for all other benefits except Veterans Administration Improved Pension.
• Must apply for a Social Security Number.

LONG-TERM CARE MEDICAID COVERAGE GROUPS

1. Nursing Home: Aged, or disabled individuals needing long-term nursing care may be eligible for Medicaid benefits. Long term care is defined as nursing care provided for at least thirty (30) days, whether the nursing care is provided in a hospital, nursing home or at home through the home and community-based health care program (i.e., Community Care Services Program).
2. Community Care Waiver Services (CCSP): Aged, blind, or disabled individuals who are in need of nursing home care but remain at home with the aid of Community Care Services may be eligible for Medicaid benefits. Community Care Services are specific health care services rendered to an individual at home in lieu of nursing home placement. Services provided include Home-delivered services, Homemaker Aide Services, Emergency Response Services, Respite Care, Adult Day Rehabilitation, and Alternative Living Services.
3. Katie Beckett or Deeming Waiver Coverage: Children under age eighteen (18) who are chronically sick and need nursing home care but could stay home with good home care that costs less than nursing home care are eligible for this coverage. The parents of these children must have income or resources that make the children ineligible for SSI. The parent’s income and resources are not counted when determining these children’s eligibility.
4. The Independent Care Medicaid Waiver Program: (ICWP) Severely disabled individual who are twenty-one (21) years of age or older, who are medically stable enough to leave the hospital but cannot do so without the support services available through this program, and who are at risk of out-of-state nursing home placement may be eligible for Medicaid benefits. The services available under this program are Case Management, Homemaker, Personal Care Services, Environmental Modification, Skilled Nursing, Transportation, Specialized Medical Equipment and Supplies, Personal Emergency Response Systems, Companion Services, Counseling and Occupational Therapy.
5. Hospice Care: Available to individuals who are terminally ill, has a medical prognosis of six months or less life expectancy, and the individual receives hospice care from an approved hospice care provider. The services available under this program include but are not limited to nursing care, medical social services, physician services, counseling services, respite care, and home health aide services.
6. Mental Retardation Waiver Program and Community Habilitation Support Services: Designed to provide in-home and community-based services to Medicaid eligible mentally retarded and developmentally disabled individuals who do not receive Medicaid benefits under a cash assistance program. MRWP Services include Day Supports, Day Habilitation, Residential Training and Supervision, Natural Support Enhancements, Therapeutic Services, Respite Care, Supported Employment, Personal Support Services, Environmental Modifications, Vehicle Adaptations, Specialized Medical Equipment and Supplies.

CHSS Services include Community Habilitation and Support Services, Specialized Medical Equipment and Supplies, and Environmental Modifications.

INCOME AND ASSETS LIMITATIONS

Financial need must exist in order for an individual to be eligible under all Medicaid programs including the long-term care coverage programs listed above. Financial criteria are divided into two groups: income and assets.

Income

Income is any item an individual receives in cash or in-kind that can be used to meet his or her need for food or shelter. The income retirement for Medicaid states that gross monthly income of the applicant cannot exceed a certain figure. The January 2022 figure was set at $2,523. The State of Georgia determines the income requirement, which changes each January. However, if an individual’s income exceeds the income limit listed above the individual may establish an Irrevocable Qualified Income Trust (QIT), also known as a Miller Trust. (Contact your local county Department of Family and Children Services for additional information).

Assets

Assets include all income and resources of the individual and of the individual’s spouse, including income and resources which the individual or such individual’s spouse is entitled to but does not receive. To meet the asset criteria, an individual must have countable resources of $2,000 or less. Resources are those assets, both real and personal property, which an individual or couple owns and can apply, either directly or by sale or conversion, by meeting basic needs of food, clothing, and shelter (like bank accounts, real property, or other items that can be sold for cash).

If the long-term care individual has a spouse who is not institutionalized or receiving home and community-based services, the resources of the spouse MUST be considered in the eligibility determination. The total combined resources of the individual and the non-institutionalized spouse must be $636,000 or less for 2022.

Family Size	Monthly Income Limit	Asset Limit
Individual	$2,523	$2,000
Couple* (*If both are receiving long-term care services)	$5,046	$3,000

ASSET PROTECTION UNDER THE

LONG-TERM CARE PARTNERSHIP PROGRAM

Most people do not like to think about the fact they may one day need long-term care services. Most people are also surprised at the costs of long-term and do not think of having to use their entire life savings to pay for those needs and services. The average private pay rate for a semi-private room in a Georgia nursing home in 2022 was $233.70 per day, or over $84,000 per year.

The Georgia Long-Term Care Partnership (Partnership) is designed to reward Georgian’s who plan ahead for future long-term care needs. The most unique aspect of a Georgia Partnership policy is the Medicaid asset protection feature. This feature provides dollar-for-dollar asset protection: for every dollar that a Partnership policy pays out in benefits, a dollar of assets can be protected from the long-term care Medicaid asset limit. When determining long-term care Medicaid eligibility, any assets you have up to the amount the Partnership insurance policy paid in benefits will be disregarded.

EXAMPLE

If your Partnership policy paid $200,000 in benefits, Georgia’s Medicaid program would allow you to keep $200,000 in assets and still qualify for Medicaid benefits. The amount of assets you can protect under the Partnership is in addition to the $2,000 everyone is allowed to keep, including any assets your spouse may be allowed to retain. The protected assets will also be exempted from estate recovery in an amount equal to the benefits paid by the long-term care insurance policy.

REMEMBER:

The Partnerships Medicaid asset protection feature is not available under other long-term care insurance policies.

The purchase of a Partnership Policy does not automatically qualify you for Medicaid.