Nursing home Medicaid is a benefit paid for by the Federal government and administered by the Georgia Department of Community Health to pay for nursing home care for those who show a medical need for such care. Along with showing a medical need for nursing home care, an applicant for nursing home Medicaid must also meet income and asset levels to receive payment for nursing home. The income and asset qualification rules under Medicaid are complex, and it is advisable to seek the existence of an experienced elder law attorney when applying for nursing home Medicaid.
Along with meeting the asset and income levels to qualify for nursing home Medicaid, a recipient of nursing home Medicaid must pay a cost share to the nursing home. The cost share is a payment to the nursing home. It is typically the entirety of the Medicaid recipient’s monthly income minus a $50 allowance for personal expenses. There are other deductions that can reduce the amount owed to the nursing home under the patient cost share. The largest deduction that decreases the cost share is known as spousal diversion, which allows a spouse in a nursing home to redirect some or all of their income to the spouse that is not in a nursing home, known as the community spouse. Under Georgia Medicaid regulations, a community spouse is entitled to have a minimum of $2,980 in income a month. If the community spouse has less income than $2,980, they can receive as much of the monthly income of the nursing home spouse as necessary to bring their income up to $2,980 a month.
For example, if the Medicaid recipient spouse receives $1,500 a month in Social Security and other income, and the community spouse receives monthly income of $1,200, the Medicaid receiving spouse can redirect the entirety of their income to the community spouse, as the combination of the two incomes is under $2,980.
If the community spouse had income of $1,600, the Medicaid spouse could only redirect $1,380 a month to the community spouse.
Lastly, if the community spouse has income over $2,980, the Medicaid spouse cannot redirect any money to the community spouse. If the community spouse has income above $2,980, the community spouse does not receive income from the Medicaid spouse, but is not required to pay money towards the Medicaid spouse’s nursing home care.
Spousal diversion is an important tool that can become a part of a Medicaid plan to reduce the amount that must be paid for long term care.