NOTE: If you have a Georgia corporation or limited liability company, your annual return is due by April 1, 2022. General News Sources: Dog Aging Project is looking for more participants National Black (African American) History Month: February 2022 (Census) Tricare coverage and Medicare explained Growing elder populations require more services, awareness NAIC Comments on […]
Aged, blind, or disabled individual means an individual who— (A) is 65 years of age or older, is blind (as determined under paragraph (2)), or is disabled (as determined under paragraph (3)), and (B) (i) is a resident of the United States, and is either (I) a citizen or (II) an alien lawfully admitted for […]
General News Sources: Oldest person in the US reportedly dies at 115 Supreme Court declines to hear case of Delphi retirees over lost pensions Big pensions are nearly 100% funded, the healthiest they’ve been since 2008 financial crisis Pre-tax vs. Roth 401(k): There’s more to consider than you think Widow’s dilemma: When to claim Social […]
In Merritt v. Ohio Department of Job and Family Services, Case No. CA2021-04-044 (12/27/2021), Jerome Merrit applied for Ohio nursing home Medicaid. His son, Glenn Merritt, arranged for Jerome’s admission to Heritagespring of West Cherster, using his healthcare and general power of attorney. The nursing home applied for Medicaid, but told Glenn that Jerome must […]
The following notices are routinely included with other correspondence from Tenncare. Below are Tenncare’s notices regarding: (1) Estate Recovery, (2) Qualified Income Trusts, and (3) Reporting changes to Tenncare.
As of December 21, 2021, Georgia has changed its Estate Recovery Program rules under Title 49 O.C.G.A. § 49-4-147.1. This change is effective July as of July 1, 2018.
As of December 15, 2021, Georgia Medicaid renewals have been extended again due to Covid-19.
General Sources: Autism Society’s Capital Connection 12-16-2021 (reviewing Build Back Better Act) National Health Care Spending in 2020: Growth Driven by Federal Spending in Response to Covid-19 (Health Affairs) House Advances Build Back Better Act (Health Affairs) Indirect Gift Tax Considerations for 2021 (The Tax Advisor) Smart moves to make with your retirement portfolio before […]
The standards for the 2022 Community Spouse Resource Allowance and Community Spouse Monthly Income Allowance have been updated in the document below:
A new Medicaid lien case is pending in the U.S. Supreme Court. The question presented is “[w]hether the federal Medicaid Act provides for a state Medicaid program to recover reimbursement for Medicaid’s payment of a beneficiary’s past medical expenses by taking funds from the portion of the beneficiary’s tort recovery that compensates for future medical […]
Nursing home residents and their personal representatives have a right to stay informed regarding their condition and their care. 42 CFR § 483.10(g) provides: (1) The resident has the right to be informed of his or her rights and of all rules and regulations governing resident conduct and responsibilities during his or her stay in […]
The worksheet below is not intended as a substitute for legal advice. It requires an understanding of the Medicaid budgeting process in the State where the applicant is applying for Medicaid. However, if the user knows how that process works, then this worksheet is designed to provide a “quick and dirty” estimate of the patient […]
Gifting is usually a last resort when creating a Medicaid Plan. The reason is gifts trigger a transfer of resources penalty. The Medicaid Transfer Penalty Worksheet can be used to calculate the penalty, but an additional worksheet is helpful when calculating the amount of income a Medicaid applicant must generate to private pay through the […]
News Sources: Elder Law Attorney Daniel Tully has 9 questions you should ask before you or a loved one goes into a nursing home Elder Law Attorney Janet Colliton answers “Where is home when you have more than one?” Social Security proposal would raise revenue and temporarily enhance benefits Nursing homes can now lift most […]
Federal regulations require Medicaid agencies to afford individuals the opportunity to apply for Medicaid without delay. 42 CFR § 435.906. An application may be filed on the internet, by telephone, by mail, in person and through other commonly used electronic means. 42 CFR § 435.907. All applications must be signed under penalty of perjury. 42 […]
Sometime people assume monthly income counts toward the $2,000 resource limit. Assets (anything of value) are either income or resources. ” An asset cannot be considered income and a resource during the same month.” Georgia ABD Manual 2300-1 and 2300-2.  See also POMS SI 01110.600 B.3.This confuses many people because they are trying to keep bank […]
Every year the Supplemental Security Income (SSI) benefit rate and Medicaid resource allowances are updated. For 2022, the federal benefit rate increased by 5.9%. There was no change in the SSI benefit rate. The SSI monthly benefit increased to $841. This means the Medicaid income cap increases to $2,523 of gross monthly income. The one-third […]
H.R. 1717, known as the Protecting Married Seniors from Impoverishment Act of 2021, and a companion bill in the Senate (S.1099) would require States to extend Community Spouse Resource and Income allowances to couples needing in-home care. A temporary modification extending these protections was already in place through the Consolidated Appropriations Act, 2021 (Pub. L. […]
The form below was developed by the Georgia Department of Community Health and is based on Section 2342-11 of the Georgia ABD Medicaid Manual:
What are people talking about when they say you have to “spend down” to become eligible for Medicaid? Well, it can describe two different things. Most of the time elder law attorneys are referring to to resource spend-down where the applicant is trying to get below the resource eligibiity threshold. But it can also refer […]
The spreadsheet included below can be used to help total your countable and exempt resources when evaluating your eligibility for public benefits like Medicaid.
In Richards v. Georgia Department of Community Health, 278 Ga. 757 (2004), a class of plaintiffs sued DCH contending that O.C.G.A. § 49-4-149 was illegal as applied. The Department’s position was that its claim for reimbursement applied to all funds received by a plaintiff through litigation against responsible third-parties. The plaintiffs argued that DCH’s claim […]
News Sources: Covid-induced life changes leave millions of Americans worried about money IRS Continues Focus on Cryptoassets Georgia Attorney General Recognizes National Cyber Security Awareness Month Georgia Attorney General Supports Congressional Hearings Addressing Youth Social Media Use Dental coverage for Medicare recipients divides parties Federal auto-IRA program would be a big step forward in expanding […]
Deeming Terminates After Eligibility Is Established. Four years later, the Duprees were back in Court. At the annual review on February 29, 2012, DFCS denied eligibility due to a failure to submit documentation. The documents were then submitted and eligibility was denied with DFCS alleging petitioner was over resourced. Petitioner had not acquired any new […]
Which Home is the Homeplace? Pernie Dupree entered a nursing home on September 11, 2009. Prior to her admission, she had lived with her husband at 1 Bragg Circle since 1949. The Bragg Circle property was valued at $45,411. After hs wife entered the nursing home, due to his declining health Mr. Dupree moved into his […]
Pooled Trust Subaccount Established for Individual Over 65yo. An 83 year old deposited $12,320 into a pooled trust in August 2008. In November 2008, he applied for Medicaid. His application was denied. The parties stipulated the trust complied with 42 USC 1396p(d)(4)(C), but the Department took the position a transfer penalty should be applied. The […]
Direct Transfer to Disabled Child; Previously Unknown Resource. Applications for Medicaid were filed on November 24, 2008 and January 8, 2009. The first application was denied for failure to provide documentation. The second was approved on April 16, 2009 with assessment of a penalty through 2009. The transfer was directly to a disabled child rather […]
Annuity; Transfer Penalty for Failing to Name State as Beneficiary. Petitioner, a 95 year old nursing home resident, applied for Medicaid on December 15, 2008. DFCS denied eligibility and imposed a transfer of resources penalty because she had purchased an annuity without naming the State of Georgia as a beneficiary. The annuity was irrevocable and […]
Single Premium Life Insurance Contract; Penalty Reversed. On November 5, 2008, Petitioner filed an application to purchase a Single Premium Pure Endowment Life Insurance Contract. She paid $89,500 for the policy which, in five years, would pay her children $91,327. The contract stated there was no cash surrender value and that no benefits would be […]
No Retroactive Application of Policy Changes Permitted; Payments for Renovations to Accommodate Petitioner Permitted; Payments Consistent with Prior Accepted Obligation Permitted. Petitioner was hospitalized with a stroke in 2008, after which she went to live with one of her sons until she was re-hospitalized in November 2008. Thereafter, she remained in a nursing home. Petitioner […]
Personal Services Contract rejected. Petitioner was admitted to a nursing home in October 2008, where she continued to stay. At the time, she had $36,332 in resources. Petitioner entered into a contract with Ms. Hailey to provide personal care services at the nursing home for life for $23,000. Her life expectancy was 10 more years. […]
VA Improved Pension Not Income. Petitioner applied for Medicaid on November 4, 2008. Petitioner was the surviving spouse of a veteran eligible for VA Improved Pension. At the time, the income cap was $2,022 and, if the Improved Pension was included in Petitioner’s income, then her gross monthly income exceeded the income cap. Of Petitioner’s $1,056 […]
Direct Transfer to disabled child allowed from date ALS was diagnosed. Petitioner made transfers directly to a disabled child with ALS. However some transfers were made prior to the determination of disability and others were made after the disability determination. DFCS attempted to penalize all transfers since they were directly to the disabled child rather […]
Increase CSRA in Superior Court, followed by Application and Fair Hearing. After admission to a nursing home, but prior to application for Medicaid, the Superior Court in Glascock County issued an order setting aside all of Petitioner’s marital resources for the Community Spouse’s benefit for the purpose of generating sufficient income to reach the MMMNA. […]
Transfer penalty cannot be imposed where transfer was exclusively for purpose other than to qualify for Medicaid. Petitioner was admitted to a nursing home with dementia and her doctor states she cannot make legal decisions. Petitioner owned her home jointly with her daughter following the death of Petitioner’s husband. The daughter then conveyed the home […]
The Limit is the Limit, Part 3. Petitioner was originally admitted to Ridgewood Manor, a nursing home in Dalton, and later transferred in July 2007 to Shepherd Hills in Lafayette. Meanwhile, in May of 2007, her Community Spouse was admitted to a hospital and remained either hospitalized or in a nursing home until his death […]
Use of Burial Funds for Care Results in them Being Treated as Income. In a one page decision, the ALJ affirmed an increase in Petitioner’s cost-share for December 2008 where Petitioner used funds set aside for burial for personal care. The ALJ noted this decision did not impact eligibility for any month other than December […]
Penalty Affirmed After Life Estate Conveyed; Hardship Waiver Unavailable Because No Legal Action was Taken to Recover Property. Petitioner, a divorced individual, acquired a life estate in business property with his ex-wife owning the remainder interest. He entered a nursing home in March 2008 and his Medicaid application was denied after the caseworker valued his […]
Transfer Penalty Reversed Where Care Services Were Provided Under Agreement. Petitioner was discharged from a nursing home to home in 2004, where she remained until she returned in 2008. At the time of discharge she agreed to transfer her property valued at $262,970 on the 2006 assessment (when the transfer occurred) if her son provided […]
Cash Value of Life Insurance Cannot Be Designated as Burial Fund. Denial of eligibility was affirmed where Petitioner had a life insurance policy with a face value of $25,000 and a cash value of $2,354 because cash value cannot be designated as a burial fund. Note: compare old Section 2312 with current Section 2312. OSAH-Unknown-Teate-3-2008.pdf (March 13, 2008).
When Determining Value, Equity Value is CMV Minus mortgages and Liens. Petition created a revocable living trust in 2006. In July 2006, her granddaughter charged in excess of $30,000 on Petitioner’s credit cards before the granddaughter was hospitalized. Thereafter, Petitioner fell behind on the mortgage and her home was in danger of foreclosure. Petitioner and […]
No QIT, No Medicaid if Income Exceeds Cap, Part 2. Petitioner entered a nursing home in June 2008 and filed an application for Medicaid. DFCS did not receive or act on the application until July 22, 2008. As a result of inaction, Petitioner did not know that a QIT was needed because income exceeded the […]
Life Insurance Snafu. Petitioner and Respondent stipulated facts in this case. Petitioner applied for nursing home Medicaid in March 2008. DFCS denied the application because Petitioner had three life insurance policies with a cumulative face value of $13,831. Since the face value exceeded $10,000, the cash value of the policies was counted toward Petitioner’s $2,000 […]
No Penalty For Transfer to Disabled Child. DFCS imposed a transfer of resources penalty where Petitioner transferred cash assets to a disabled daughter. DFCS’s reasoning was that cash assets were transferred to the disabled child outright as opposed to transferring them to a trust for her sole benefit. Citing 42 U.S.C. § 1396p(c)(2)(B)(iii) and Section 2342 of the […]
No QIT means No Medicaid If Income Exceeds Cap. Petitioner entered the nursing home in July 2007 and applied for Medicaid in August 2007. No one told Petitioner a qualified income trust was needed. A denial was sent in October and Petitioner reapplied in November 2007, establishing the QIT by December 17, 2007. Eligibility was denied for […]
Determining Which Property is the Exempt Homeplace; Whether Jointly Owned Second Property was Exempt. Petitioner lived at her residence in DeKalb County from 1960 until 2002 when she moved to her daughter’s home on Klondike Road in DeKalb County. From there, Petitioner went to an assisted living facility and then, in December 2006, a nursing […]
Penalty Reversed Where Home was Given to Caregiver Child. In 2002, Petitioner’s daughter moved into Petitioner’s home to provide care. In 2003, Petitioner was bedridden after back surgery; the daughter continued providing care on a full-time basis and also paid some of Petitioner’s expenses. On December 25, 2004, Petitioner gave her home to her daughter, […]
No Penalty Where Transfer Reimbursed Third Party for Paying Applicant’s Expenses. Petitioner was admitted to a nursing home on May 7, 2008 and remained there until her death on July 24, 2008. Petitioner filed an application for Medicaid on July 3, 2008, seeking retroactive coverage. The application was denied after DFCS discovered a $22,668.56 transfer […]
The Limit is the Limit, Part 2. Petitioner entered the nursing home on April 17, 2007 and applied for Medicaid on February 22, 2008. Petitioner sough retroactive coverage for November 2007 through January 2008. Unfortunately, Petition was over resourced. After designating stock as a burial resource, she still had $5,569.73 on November 1st, $4,077.13 on […]
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