Although many people understand that the Medicaid program can help seniors and their families pay for Nursing Home care, there is a lot of confusion about the details. Below are some of the most Frequently Asked Questions about the 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. Unlike Medicaid, Medicare eligibility is not based on financial need.
Medicaid is a joint federal-state program. It pays for medical care for people who do not have the income or resources to pay for the care they need. To qualify for Medicaid, you must show that you meet both Medicaid’s financial eligibility criteria and Medicaid’s other eligibility criteria.
Why do I need to know about Medicaid? 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 Medicaid’s financial eligibility requirements?
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.
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 is currently $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.
Note: Numbers are current as of May 30, 2015, but are subject to change.