Rules and Regulations of Georgia Medicaid Benefits for Nursing Home Patients

Some nursing homes in Georgia require private-pay only, though most accept Medicaid-funded residents. These Medicaid-approved homes experience state inspections and regulations on a regular basis. The Georgia Department of Medical Assistance administers the state's Medicaid program with its complex rules. A senior required to enter an assisted-living care facility, desires to preserve most of her assets for her family and should understand the complexities of law she faces. At this time, insurance companies do not provide a major source of funding for nursing homes.

Eligibility

• Eligibility for Medicaid funding for an assisted-living care facility must satisfy three components. The first of these includes medical reasons--the person must require a level of care--only available in a nursing home. The second covers income and the third covers assets. To qualify, the senior must not have countable assets of more than $2,000. A home can be exempted from this financial requirement, providing a spouse still lives there, or there is intent on the part of the applicant to return to the home. Other exemptions include an in-resident caregiver who lived in the home during a qualifying period.

Assets

• Many seniors transfer assets to relatives in a bid to qualify for Medicaid funding. It is possible to do this, but pitfalls ensue. In some cases, a "look-back" period occurs where Medicaid administrators look at what happened in month's prior to a senior's acceptance in the assisted living home. Assets transferred are divided by the average monthly cost of the facility's fees. The senior may have to come up with the money for those months.

Safeguards

• In Georgia, a nursing home resident is allowed to keep $30 a month for her personal use. Remainder is paid towards her nursing home costs. A resident changing from private pay to Medicaid-paid cannot be asked to leave an assisted living care facility for that reason. Georgia has an ombudsman who investigates any complaints from nursing home residents or relatives.