Nursing home Medicaid is a program administered by the State of Georgia and funded by the Federal government to provide coverage for nursing home care. Applicants for nursing home Medicaid must show both: that they have a medical condition that requires skilled level nursing home and meet financial limits on both the income and assets that can be retained and still receive nursing home level care. Information on these requirements can be found in the Medicaid Planning section of this website.
To be approved for Medicaid, an applicant must file a Medicaid application with DFACS. This can be done either online or by mail. At first glance, the application seems easy, as it is only a few pages of questions. But, like many things, the complexity is in the details. There are significant requirements in terms of the form of documentation that must be provided to support the answers to the questions on the application. If the documents provided raise additional questions for the Medicaid caseworker reviewing the application, additional documentation is required to answer such questions. Lastly, bank statements and other documents must be scrutinized to ensure that there were no gifts or other transfers subject to penalty made within sixty months before the date of application.
Most nursing homes will offer to submit the nursing home Medicaid application for the nursing home resident. This is typically not beneficial for the Medicaid applicant, as in an attempt to get paid as quick as possible, the nursing home may fail to consider the issues outlined above. This can result in a denial of nursing home Medicaid benefits and a possible penalty precluding the award of benefits for months or even years in the future.
The nursing home should only be permitted to file the application for Medicaid if the applicant is very certain that:
• Current Medicaid rules on assets and income are satisfied.
• There were no transfers in the last sixty months.
• The income of the Medicaid applicant is below the Medicaid threshold.
• The Medicaid applicant does not have any assets that need to be protected from a Medicaid lien. This is common when the Medicaid applicant has a house.
As is evident from the list above, the times where the nursing home can be trusted to submit the Medicaid application are very rare. For all other applications, the services of an experienced elder law attorney should be used. The investment in hiring an attorney will be recouped by protection of the assets of the Medicaid applicant and faster Medicaid approval.