MEDICAID & LONG-TERM CARE

Will Medicare pay for a long-term nursing home placement?

Upon what standard does Medicare coverage of skilled nursing care end?

Will a resident receive lesser care if the payment source is Medicaid?

Isn’t it more difficult to get into a good nursing home if the resident will be on Medicaid?

What makes it more likely to get into the nursing home of choice?

What if a resident enters on Medicare or private pay and then converts to Medicaid?

Can a nursing home condition admission upon a promise to stay private pay for a period?

Can a nursing home require a family member to guarantee private payment for a period?

If a resident seeks Medicaid, will the state take all the resident’s property upon approval?

What is “Medicaid planning”?

Is Medicaid planning legal and ethical?

Is there a limit to the size of an estate that can be restructured as part of a Medicaid plan?

After implementing a Medicaid plan, will I have access to money to care for mom?

Yes. There are a variety of planning opportunities in Georgia. Each allows access to funds in varying degrees. Keep in mind that the whole point of doing Medicaid planning is to create the ability to provide supplemental care to the nursing home resident. If access is too limited, then the plan misses the point.

What about buying long-term care insurance?

Long-term care insurance is an excellent idea for those who are insurable from a health perspective and who can afford it. For those already in a nursing home or who face imminent placement, this insurance will no longer be available. Accordingly, it is imperative to seek advice about insurability and cost as early as possible. Because most people facing the prospect of placement are uninsurable or the cost is prohibitive, Medicaid planning becomes the only alternative. Note also that the state of Georgia is in the process of creating the Georgia Long-term Care Partnership Program. While the details are still being worked out, the general premise of this program is to encourage people to buy long-term care insurance by allowing an increased Medicaid asset limit once the insurance benefits are exhausted. To learn more about the general concept, go here:

How quickly can implementation of a Medicaid plan result in eligibility for assistance?

Very quickly in Georgia. If an individual is in a nursing home or about to be in one, eligibility can usually be established within a matter of a few weeks or at most a few months. This is in stark contrast to the possibilities in other states where people must wait for up to five years to pass.

Why doesn’t Georgia have the five-year rule?

It does. But this is a rule that applies only to planning through gifting or irrevocable trusts. In reality, there are at least three types of planning available in Georgia. So long as gifting or an irrevocable trust are not utilized, then the five-year rule is not invoked and eligibility can ensue very quickly.

What are the resource eligibility rules in Georgia?

In 2017, assets that are considered non-exempt are limited to $2,000 for a single person and $120,900 for a couple (total of $122,900). Assets that are considered exempt are not subject to any valuation limit except that a single person’s home is limited to no more than $556,000 equity.

Can a couple simply place all assets in the healthy spouse’s name and expect to qualify?

Generally no. Moving assets into the healthy spouse’s name normally accomplishes nothing from a Medicaid perspective in Georgia. When determining a spouse’s eligibility, all assets owned in either spouse’s name will typically be included for purposes of the $122,900 test.

What are the income eligibility rules in Georgia?

In 2017, the standard income limit is $2,205. Note that this test looks only at the income of the nursing home resident. The community spouse’s income is not considered. If an individual has income that exceeds $2,205, execution of a Miller Income Trust will be required to gain eligibility. A Miller Trust is a simple legal entity created to serve as a conduit for the resident’s income. Following execution, the trustee will be charged with depositing the resident’s income into the trust each month and then paying it out according to specific rules set by Medicaid. Those rules generally allow the resident to receive a $50 personal needs allowance, allow a deduction to cover the cost of Medicare supplemental insurance, and allow a deduction to divert income to a spouse living at home whose income is below $3022. Any remaining funds generally must be paid to the nursing home.

Can planning be done today if nursing home placement is several years down the road?

Yes. Where placement is in the distant future, it is always advisable to seek long-term care insurance if one is insurable and it is affordable. Where placement is on the intermediate horizon, planning can be initiated ahead of time so long as it is understood that there is always the risk that changes in the law will either alter or destroy altogether the effect of that preemptive planning. Accordingly, those contemplating this question should definitely seek the advice of an elder law attorney to determine whether preemptive planning is appropriate.

Can’t I plan ahead and apply for Medicaid now to avoid complications with law changes?

No. An application for nursing home Medicaid cannot be filed until the person is actually placed in the nursing home.

My neighbor told me to give everything to my kids. Is this good advice?

This is a very dangerous possibility. Whereas such drastic action might help, it could also create a bigger problem than was there originally. Accordingly, it is critical to seek legal advice prior to gifting anything.

My neighbor told me to put all I own into a trust. Will this help at all?

Depends on timing. As a result of changes in the law since 1993, trusts are generally unhelpful or will actually create trouble for those seeking assistance from Medicaid. Having said this, it is possible that a very skillfully drafted irrevocable trust might provide some benefit if it is settled more than five years prior to the need for nursing home placement. Moreover, it might be possible to utilize a special needs trust as part of Medicaid planning in Georgia if the circumstances are appropriate.

Will the family home have to be sold in order to get help from Medicaid?

Generally no. The home is considered an exempt asset and need not be sold so long as the equity in the home is less than $552,000 (equity limit applies only to an unmarried applicant). If equity exceeds this amount, additional planning may be needed before eligibility can be achieved. Moreover, there are other factors to consider. First of all, a resident’s income will no longer be available to cover costs associated with a mortgage, taxes, insurance, and general maintenance (see next question about patient liability). Accordingly, it may become necessary to sell the house from this perspective notwithstanding the fact that Medicaid allows the resident to own it. In this case, the proceeds of the sale would destroy ongoing eligibility for Medicaid unless they are immediately restructured as part of an efficient Medicaid plan. This is not uncommon and actually is preferable to some who are glad to have access to the equity in the home to provide supplemental care to the resident.

Once a resident is on Medicaid, what happens to their income?

It depends on whether they are single or married. For a single person, all income other than a $50 personal needs allowance and that which is required to cover health insurance premiums will generally have to be paid to the nursing home as the resident’s fair share of the bill. This is called patient liability. For a married couple, the answer is significantly different. To the extent that the community spouse has low income, the nursing home resident will be able to share some or all of his income with her so that she does not become impoverished.

Will Medicaid cover the cost of assisted living?

No in almost all circumstances. Assisted living facilities generally provide custodial care that does not fall within the Medicaid arena. Medicaid will typically only pay for care provided in a skilled nursing facility. While this is true as a general rule, there is a Medicaid program in Georgia called the Community Care Services Program that can help with assisted living on very rare occasions.

Will Medicaid pay for any home health care?

Possibly. The Community Care Services Program is a Medicaid program designed to provide care for people in the home who would otherwise require nursing home placement. The underlying premise of this program is wonderful in that it seeks to prolong a higher quality of life for the individual at home while at the same time saving the state money because the cost of care in the home is less than the cost in a nursing home. While this sounds excellent in theory, the problem is that the program is woefully underfunded and usually has a lengthy waiting list. Those seeking more information about CCSP should call the Atlanta Regional Commission at 404-463-3333.

FOLLOW THIS LINK FOR A WEBSITE WITH AN EXCELLENT COMPILATION OF LONG-TERM CARE PLANNING AND NURSING HOME INFORMATION:

                    Long-term Care Options in Georgia

                    Long-term Care Planning

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