Nursing home Medicaid is a program funded by the Federal government and administered by the State of Georgia that pays for nursing home care for those who have a medical need for such care. To receive nursing home Medicaid, an applicant must meet both asset and income limitations to receive nursing home Medicaid. These asset and income limitations are discussed in other posts on this blog. In this post, we will cover calculating the monthly amount a Medicaid recipient will owe to the nursing home once Medicaid is approved.
The patient liability share is the amount that the Medicaid recipient owes monthly to the nursing home. On the most basic level, this is the amount of monthly income of the Medicaid recipient minus the allowance for personal needs, which currently is $50. There are several deductions that reduce the income of the Medicaid recipient for purposes of computing the patient liability, and thus reduce the monthly amount owed. The income can be reduced for any Medicare premium paid from Social Security. The amount of income can also be reduced if the Medicaid recipient has a spouse with insufficient income. Medicaid provides a certain minimum level of income for the spouse of a nursing home resident, as of 2016 this amount of income is $2,980. If the spouse of the Medicaid recipient has income below this level, the spouse can receive as much of the Medicaid recipient income as needed to bring them up to that level. If the spouse has income of their own that is equal to or greater than the level, the spouse cannot receive any income from the Medicaid recipient.
It is not uncommon for DFACS to miscalculate patient liability. DFACS should be contacted if the patient liability requested is more than that required by law. An experienced elder law attorney can provide assistance in calculating the appropriate patient liability and other Medicaid qualification requirements.