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How Does Medicaid Eligibility Work?

Updated: Dec 11, 2019




Medicaid Eligibility


Question: My aging father may need to go into a nursing home soon.  How am I going to pay for nursing home care?

Answer: This is a question that I hear quite often.  The most common answer is applying for Medicaid, and Georgia Medicaid is an extremely complicated process. The first thing you need to know is Medicaid is a combination of a federal and a state program.  This means that Georgia Medicaid is different from Oregon Medicaid which is different from Florida Medicaid.  If your father is a Georgia resident, you need to know about Georgia Medicaid, but if he is an Oregon resident, you need to know about Oregon Medicaid. 

Before thinking about Medicaid, it is important to ensure the applicant’s estate plan is in order.  It is vitally important that your father have a Durable Power of Attorney in place.  If he is competent now, this is the first thing which I would recommend.  Whether he decides to appoint you as his Agent or not, the importance of having someone who can act on his behalf once he is in the nursing home cannot be overstated. 

In order to qualify for Georgia Medicaid, there is a five-part test which will need to be passed.  For each part of the test, we must be able to prove that your father meets the criteria by submitting documents to the State.



1: United States Citizen In order to qualify for Georgia Medicaid, you generally must be a United States Citizen.  This is one of the easiest tests to provide proof of.  Was your father born in the United States?  Does he have a birth certificate showing he was born in in the United States?  Is he a lawful permanent resident with the appropriate documents showing his status?  If the answer to these questions is yes, your father meets part one of the test and we can move on to part two!

2: Georgia Resident Like the first test, in order to qualify, your father needs to be a resident of the State in which you are applying for Medicaid.  Proving residency is a relatively simple process.  We look at where your father has his driver’s license or identification card, where he has lived for an extended period of time, where his car is registered, where he is registered to vote, etc.  If we can show the State that factors like these lead to a significant connection to the State of Georgia, your father will be deemed a resident for purposes of Medicaid.

3: Medical Necessity Understandably, in order to qualify for nursing home Medicaid an applicant must need nursing home care for medical reasons.  In the medical field, the daily activities we perform for self-care are broken down into five basic categories: bathing, eating, dressing, toileting, and transferring.  These five activities are considered the Activities of Daily Living (“ADLs”).  An applicant must need assistance with at least two of the five ADLs in order to qualify for nursing home Medicaid.  One important note is that saying an applicant needs assistance does not necessarily mean he is unable to perform the activity for himself.  For example, if your father can shower on his own but is unable to wash his back on his own, that would mean he needs assistance with the ADL of bathing.  Similarly, if he is able to pick out his clothes and put them on but is unable to button buttons or zip zippers, he would be deemed as needing assistance with the ADL of dressing.

4. Income The fourth test which an applicant for Georgia Medicaid must pass is an income test.  An applicant must have less income than $2,313 a month in order to qualify.  This is one of the areas where the qualification criteria is different based on the state where the applicant resides.  In some states this maximum will be higher and in some states it will be lower.  For example, according to medicaidplanningassistance.org, in Maryland the only limit to income is the cost of the nursing home.  So the question becomes, what happens if the applicant receives more income than $2,313 a month?  Federal law allows a state to adopt procedures which will allow an applicant to qualify for Medicaid even if they receive more income than the monthly maximum, provided the applicant agree to create a Qualified Income Trust (“QIT”), also frequently known as a Miller Trust.  A QIT serves as a buffer, essentially lowering the applicant’s income below the maximum so he can qualify for services.  If your father receives more income than $2,313 a month, you will need to contact an Elder Law Attorney to assist you with preparing a QIT in order to ensure he qualifies for Medicaid.

5. Resources The final test which a person applying for Medicaid has to pass is a resources test.  One of the most common questions to get in this area of the law is “How much assets can I have for Medicaid.”  Under Federal law, a person can have a maximum of $2,000 of countable assets to qualify for nursing home Medicaid.  The key word in that sentence is “countable”.  There is a laundry list of items which are noncountable assets which are not considered when determining whether someone is Medicaid eligible.  For example, in Georgia a house with equity up to $500,000 is a noncountable asset and wouldn’t affect someone’s Medicaid eligibility.  Additionally, any retirement accounts (401(k), IRA, annuities in pay out status, etc.) are also exempt assets for Georgia Medicaid purposes.  Each state is different as to what assets are considered countable and noncountable, so it is highly recommended that you speak with an Elder Law Attorney in your state to determine which of your father’s assets are countable.



What happens when a person is over the resource limit?  Does having too many resources mean you can’t qualify for Medicaid?  There are many tools in the Elder Law Attorney’s arsenal which can be utilized to allow a person who otherwise might not qualify, to qualify for Medicaid.  These tools are all very fact specific and as such, the best way to determine whether any of them might apply is to schedule a free consultation with us.  We will ask may questions during our consultation to figure out what tool will be best applied to your situation.  For example: Does the Medicaid applicant have a caregiver child who has lived in his house for two or more years?  Is the applicant married or single?  Are there any disabled children in the family?  Has the applicant prepaid for his or her funeral?  Each of these questions leads to different options for helping the applicant save assets for his or her legacy.  If you have any questions or have an aging parent who may need nursing home assistance in the near future, please give us a call at (678) 340-3223 for a free no obligation consultation where we can discuss more specifics to your situation!

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