Medicaid in Georgia

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 Medicaid eligibility and planning:

There are many different types of Medicaid in Georgia. For simplification’s sake, this article attempts to clarify Medicaid as it relates to nursing homes, personal care homes or personal care in the individual’s home (CCSP or Community Care Services Program). To be eligible for Medicaid for long term care in a personal care home or a skilled nursing home or for Medicaid to cover home care in your/your loved one’s home, one must be qualified both financially and medically for care as determined by medical evaluation.  

Financial Qualifications:

If the applicant has countable assets between $2,000 - $12,500 (or $25,000 if married), one can probably avoid retaining paid Medicaid planning help by engaging in self-planning. If the applicant has countable assets over $12,500 or $25,000 if married or only one spouse is applying, then it is probably prudent to retain an Elder Care Lawyer, in advance of applying for Medicaid as the planning techniques become considerably more complicated. If income is slightly over qualification level, there is a simple option called an irrevocable funeral trust. This is essentially meeting with a local funeral home and pre-paying a funeral and all the associated expenses. The family allocates the amount of money by which they are over the Medicaid limit ( up to about $10,000) to the irrevocable funeral trust and Medicaid no longer considers that money a countable asset.

Georgia has the same income limits for individuals receiving care in nursing homes as those receiving care in the community. For 2018, this monthly gross income limit is $2,250 (or $27,000 per year). For married applicants with both parties applying for care in the home through CCSP, the income limit for each spouse remains the same as for a single applicant. The total value of an individual’s financial resources or “liquid assets” (Savings, stocks, bonds, cash, annuities, 401-k and IRA accounts) must be less than $2,000. Couples can retain up to $3,000. If only one spouse applies then the non-applicant spouse can have up to $123,600 in assets, plus the individual applicant asset limit of $2000. The asset limit excludes the applicant’s primary vehicle and the value of their home equity up to $572,000, if the applicant or their spouse lives in the home. An exception to the income limit also exists when one spouse of a married couple is not applying for Medicaid. A certain amount of the applicant’s income can be shifted to the non-applicant spouse to provide them with a livable income (Spousal Diversion). We can help by referring to local elder care lawyers that specialize in Medicaid planning in your area. 

Benefits and Services

The CCSP program provides a variety of services and supports to individuals in their homes or through care in Medicaid-accepting personal care homes. Services are determined on a case-by-case basis and can include any of the following. Program participants are given the flexibility (within limits) to select from whom they receive these care services. Providers must be qualified and willing to accept the Medicaid payment rates.

• Adult Day Health Care •Personal Care Home •Home Delivered Meals

• Home Health Care – includes skilled nursing, speech, physical, and occupational therapy

• In Home and Out-Of-Home Respite Care• Personal Emergency Response Services 

• Personal Support Services – Housecleaning, shopping, assistance with meal preparation, and assistance with activities, such as bathing, mobility, using the bathroom, etc. Allows individuals the flexibility to hire the home care company (that accepts Medicaid benefits) of their choosing.

 Medical Qualifications:

Any person that requires ongoing skilled nursing care, is mentally impaired with Alzheimer's or other dementia diagnosis or is unable to care for him or herself will qualify. If skilled nursing care is not required, then many Medicaid programs link qualification to the number of activities of daily living (ADL’ s) with which an individual requires assistance, such as dressing, bathing, eating, cooking etc. In general, a "nursing home level of care" is required, but each state defines that level of care differently.CCSP Medicaid Eligibility GuidelinesGeorgia Medicaid’s Community Care Services Program (CCSP) is a program that is coordinated through the Area Agency on Aging (AAA) organization. It is designed to help frail older adults remain living in their own homes or communities and to receive services in those locations as an alternative to nursing homes. Sometimes referred to as a nursing home diversion program, this type of program helps the state keep nursing home costs low and is generally preferred by families. CCSP may have a waiting list and individuals are prioritized based on their levels of impairment and unmet needs. From application to initial start of services, individuals can generally expect it to take 2-3 months, unless the medical needs are not significant enough to qualify for services, in which case the individual will remain on a waitlist and it may take longer for services to start. The highest needs individuals on the list rise to the top of the list. To qualify for CCSP, individuals must first qualify for Medicaid. Applicants must be a resident of Georgia, and medical and financial eligibility requirements must be met (see above). Documentation from a doctor indicating medical needs will also need to be provided. After a senior is in any nursing home for 60 days with Medicaid in a long-term bed (as opposed to rehab) they can be transitioned onto CCSP and ‘jump’ the waiting list (per a local elder care lawyer).

 When is CCSP appropriate? 

CCSP Home Care is generally appropriate when the senior has 1.) a secure place to live alone or with others, and 2.) only needs care provided for up to the CCSP limit of 40 hours per week to meet their evaluated medical needs. CCSP in a personal care home is generally appropriate when the senior does not have a secure place to live, yet is independent enough in toileting, ambulating and memory needs to live in a personal care home with some assistance in bathing, dressing, meal preparation provided, etc. If the individual has moderate or severe memory issues, significant medical challenges, or is not semi-independent in their toileting needs, they will likely be referred to a skilled nursing home for a long-term bed. This can also be paid for by Medicaid if financial and medical qualifications are met(see above), known as Nursing Home Medicaid. An individual who moves to a nursing home into a long-term bed but then improves to the point they can return home, can also be assisted with a move back home through another program of the Area Agency on Aging Services.  How to Apply for Medicaid CCSP for a personal care home or care in the homeMore information about the Medicaid CCSP program is available through any Area Agency on Aging Organization across Georgia. Because the Area Agency on Aging organization has many programs for seniors, when you call it will be helpful to let the receptionist know you would like to talk to an intake worker about CCSP for 1.) home care, or 2.) CCSP for a personal care home.Legacy Link is the Area Agency on Aging organization that serves Hall, Banks, Dawson, Forsyth, Franklin, Habersham, Hart, Lumpkin, Rabun, Stephens, Towns, Union and White County. They can be reached at 855-266-4283 or 770-538-2650 or www.legacylink.org For Cherokee, Clayton, Cobb, Dekalb, Douglas, Fayette, Fulton, Gwinnett, Henry, Rockdale, and the city of Atlanta, the Area Agency on Aging Organization is Atlanta Regional Commission (ARC, formerly ADRC) and can be reached at www.Empowerline.org or by calling 404-463-3333. For Clarke, Barrow, Elbert, Greene, Jackson, Madison, Morgan, Oconee, Oglethorpe and Walton Counties, the Area Agency on Aging Organization is North East Georgia Regional Commission (NEGRC) and they can be reached at 707-583-2546 or 1-800-474-7540 or at www.negrc.org. After the AAA has screened the applicant and there are available slots for new participants, then the applicant must complete a Medicaid application.