Updated January 3, 2019
In Georgia, Medicaid is a very common source of funding for long-term care. Approximately 72% of nursing home residents in Georgia use Medicaid to pay for their nursing home care. Without Medicaid, long-term care like nursing homes, assisted living facilities, and home health care is unaffordable for most people. In 2018, the average daily cost of a private room in a nursing home in Georgia was approximately $223, or over $81,000 per year. Private health insurance policies generally do not cover long-term care, and very few people purchase private long-term care insurance policies. Medicare coverage for long-term care services is limited. As a result, Medicaid picks up the tab for many Georgians who need long-term institutional care or home care.
There are several different ways to become eligible for Medicaid in Georgia, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.
People who are sixty-five or older, disabled, or blind, can qualify for Medicaid if they also meet income and asset limits. Georgia’s Medicaid program for elderly, blind, and disabled residents is called aged, blind, and disabled (ABD) Medicaid. If you receive Supplemental Security Income (SSI), then you automatically qualify for ABD Medicaid. If you are elderly, blind, or disabled and need long-term care in a nursing home or in the community but are not receiving SSI, then your monthly income must be less than $2,250 (in 2018) to qualify for ABD Medicaid.
If your income is above the limit, you can still qualify for Medicaid in two other ways. First, you can put your extra income each month into a special bank account that is set up under the terms of a Qualified Income Trust (also known as a Miller Trust). For help with a Qualified Income Trust, consult an attorney.
The second way to qualify for Medicaid if you are over the income limit is through Georgia’s Medically Needy Program. In the Medically Needy Program, you can use medical bills that you incur each month to “spend down” your income and qualify for Medicaid. The program is available to pregnant women, children, the elderly, and blind or disabled adults.
In 2018, the income limit for the ABD Medically Needy Program is $317 per month, meaning that you must show that you have incurred medical expenses each month that would leave you with no more than $317. Once you show that you have those expenses, you qualify for Medicaid coverage for the rest of that month.
To apply for ABD Medicaid or the Medically Needy Program, contact your local office of the Georgia Division of Family and Children Services.
To qualify for Medicaid in Georgia, you must have less than $2,000 in resources. The resource limit is the same regardless of whether you are in a nursing home, receiving community care, or living independently. Resources are assets like money and property. A couple can have $3,000 in resources and still qualify, unless they are qualifying under the Medically Needy Program, under which they can have $4,000 in resources.
There are special "community spouse" rules that allow a spouse who is remaining in the community (at home or with relatives rather than in a long-term care setting) to keep more assets and income when the other spouse is in a long-term care institution.
Some property does not count toward the resource limit. As of 2018, in Georgia, your home is exempt unless you have more than $572,000 in equity in it. Your household goods are also exempt. In addition, Georgia will not count one car as part of your resources, regardless of its value.
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you have a physical or mental impairment, or a combination of the two, that requires continued nursing care under the supervision of a doctor. This is called needing a “nursing home level of care.” You must show that you cannot care for yourself.
The severity of your impairment will determine what type of facility you need. For example, if you require round-the-clock nursing care, then you will need a skilled nursing facility. On the other hand, if you need only intermittent nursing services, but you have an impairment that prevents you from taking care of yourself, then you may need an intermediate care facility. You must meet at least the intermediate level of care for Georgia Medicaid to pay for a nursing home.
In Georgia, before you are admitted to a nursing home, you will get a Pre-Admission Screening and Resident Review (PASRR). PASRR screening is intended to assess whether you meet the nursing home level of care and also whether a particular facility can meet your needs.
Many elderly and disabled Georgians may be eligible for nursing home placement but would prefer to live in a less restrictive setting, like an assisted living facility (ALF), or to remain in their own homes with some services like home health care. Assisted living facilities are generally less expensive and less medically intensive than nursing homes. Home health care includes a wide variety of services like skilled nursing, therapy, medication management, help with bathing or getting around, and personal care aide services like meal preparation or cleaning.
If you receive ABD Medicaid, the program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you. The number of home health visits you can receive in one year is limited.
Georgia operates several Medicaid waiver programs that offer payment for assisted living facilities and home health care services to low-income Georgians. To qualify for any of the waiver programs that Georgia offers to cover long-term care costs, you must meet the intermediate nursing home level of care. That is, you must be able to show that you qualify for placement in a nursing home and that, without the services provided by the waiver program, you would need to move into a nursing home.
Georgia’s Community Care Services Program (CCSP) offers services like emergency response systems, skilled nursing and therapy services, home-delivered meals, housekeeping and chore help, and personal care assistance like help bathing or getting around. To qualify, you must be elderly or disabled, and you must have a functional impairment that is caused by physical, not mental, limitations. If you qualify, you will receive a needs assessment and a care plan outlining what type of services you will get. The CCSP also can pay for Alternative Living Services, which include the provision of 24-hour supervision, personal care, nursing supervision, and health-related support services in state-licensed personal care homes. To apply, contact your local Area Agency on Aging.
Georgia also operates a waiver program called Service Options Using Resources in a Community Environment (SOURCE). SOURCE offers case management services with primary care physicians, payments for services offered in an assisted living home, home health, personal care, delivered meals, and emergency response services. To qualify for SOURCE, you must be an elderly and disabled Georgian and be eligible for SSI. To apply, contact your local office of the Georgia Aging and Disability Resource Connection (ADRC).
Finally, Georgia’s Independent Care Waiver Program offers personal support, home health services, specialized medical equipment and supplies, counseling, emergency response systems, and home modifications to adults between 21 and 64 years old who have a severe physical impairment or a traumatic brain injury. To apply, call the Georgia Medical Care Foundation (GMCF) at 888-669-7195 or 800-982-0411, or contact GMCF at www.gmcf.org.
Georgia has a Money Follows the Person (MFP) grant from the Centers for Medicare and Medicaid Services that helps people move out of institutions and into less restrictive settings. If you are elderly or have a physical or developmental disability and live in a hospital, nursing home, or other long-term care facility, but want to live in your home or in a community-based setting, then you might qualify for assistance from the MFP program.
MFP provides funding for things like moving expenses, transportation costs, modifications to your home or vehicle, medical supplies, and other services intended to help you live more independently.
You can apply for MFP by contacting the state MFP office at [email protected] or by calling 404-651-9961.
If you do not qualify for Medicaid or do not meet the nursing home level of care, you may still qualify for some home health services if you are elderly. Georgia's Area Agencies on Aging operate the Non-Medicaid Home and Community Based Services program, which offers a wide variety of services like meal delivery, chore help, and personal care assistance. To apply, contact your local Area Agency on Aging.