Nursing home Medicaid is a program funded by the Federal government and administered by the Georgia Department of Community Health that provides coverage for long term nursing home stays for those who have a medical need for such care. Nursing home Medicaid can also be used to pay for at home care through a program called Medicaid waivers. Along with having a documented need for nursing home level care, applicants for nursing home Medicaid must also meet income and asset requirements. Further information on such financial requirements can be found on the Medicaid planning section of this website.
Nursing home Medicaid can be obtained by completing an application with the local DFACS office of the county in which the Medicaid applicant resides. The application can also be completed online. The application looks to be fairly simple and straightforward at first glance. But, there is tremendous complexity in the details of the application. All of the assets of the Medicaid applicant and their spouse must be disclosed, as well as any transfers made within a five year period of applying for Medicaid. Supporting documents, such as bank statements and deeds, must be provided to support the entries listed on the application.
Unfortunately, even if the Medicaid applicant is qualified for nursing home Medicaid, the DFACS office may still reject the application. This can be for numerous reasons, including that the needed supporting documentation was not provided or the caseworker cannot understand the documentation provided. It is important when a denial is received to pay close attention to the deadlines for appeals as failure to meet the deadline may result in a loss of retroactive Medicaid coverage.
There are two levels of Medicaid appeals. The applicant can request a fair hearing for front of an administrative law judge employed by the Georgia Department of Community Health. The judge reviews the documentation and can reverse the adverse decision. If the case is not satisfactorily resolved at the fair hearing level, a petition can be filed requesting review by either the Superior Court of the county of residence or Federal District Court. Even after requesting an appellate review of the case, it is wise to keep communicating with the local DFACS office as they may be able to resolve the case.
While it is possible to apply and obtain nursing home Medicaid on your own, if you or your spouse have significant income, several assets, or have made transfers in the last five years, it is advisable to seek the services of an experienced elder law attorney in applying for nursing home Medicaid. The investment in hiring an attorney will provide solid returns in the form of an expedited approval for Medicaid and less of a need for appeals.