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Medicaid beneficiaries cannot “fix” eligibility by giving away resources. A transfer of resources without receipt of fair market value will trigger calculation of a transfer penalty. “The penalty for an institutionalized individual consists of ineligibility for certain services for a period or periods of ineligibility that equal the number of months calculated by taking the […]

As with the income rules, the resource defaults may be changed. First, if all of the Applicant’s income has been diverted to the Community Spouse and the monthly income available to the Community Spouse still does not reach the minimum monthly maintenance needs allowance, then 42 U.S. Code § 1396r–5(e)(2)(C) provides an administrative remedy for […]

A Community Spouse is entitled to a resource allowance in addition to the income allowance. 42 U.S. Code § 1396r–5(f)(1) and (2) provide: (1)  In general An institutionalized spouse may, without regard to section 1396p(c)(1) of this title, transfer an amount equal to the community spouse resource allowance (as defined in paragraph (2)), but only […]

Deeming

The SSI regulations describe deeming as the process of considering another person’s income or resources to be your own. See 20 CFR § 416.1160 (income) and 20 CFR § 416.1202 (Resources). Prior to the time Medicaid is approved, all marital resources are deemed available to the Applicant. See 42 U.S. Code § 1396r–5(c)(2)(A). However, 42 […]

As a general rule, all countable resources owned by the Institutionalized Spouse are considered available to pay his or her nursing home bills. It does not matter whether the resource is co-owned with someone else unless co-ownership makes it impossible to liquidate the resource. Georgia ABD Manual § 2300 states that resources include cash, other […]

One strategy used when planning for Medicaid eligibility is called “spousal refusal.” It is authorized under 42 U.S.C. § 1396r-5(c)(3). There, the federal statute provides: (3) Assignment of support rights The institutionalized spouse shall not be ineligible by reason of resources determined under paragraph (2) to be available for the cost of care where— (A) the […]

The answer is, yes, maybe. At USA.gov, there are tips for caregiver support including links to programs that could pay you to serve as a family caregiver. That site offers the following insight: A caregiver helps a person with special medical needs in performing daily activities. Tasks include shopping for food and cooking, cleaning the […]

Let’s assume Betty, a widow, will go to a Georgia nursing home in the near future (using 2022 eligibility rules and limits) and has the following resources: A home A retirement account A CD designated for burial in the amount of $14,000 One vehicle Savings of $15,000 Checking of $1,600 In addition to her resources, […]

Several overriding rules control the creation and application of Medicaid eligibility criteria by the states. These rules are applicable to all mandatory and optional coverage groups, as well as all medically needy individuals.  First, a state may not impose any eligibility requirements prohibited by Title XIX. Next, the state must base coverage or optional coverage […]

In a recent case (Dep’t of Tenncare 4/20/2022), Appellant’s application for nursing home Medicaid was denied due to ownership of a life insurance policy with a cash value of $2,184.66. She had been under a limited conservatorship since June 2, 2021. The Medicaid application was filed on July 21, 2021. Neither Appellant nor the limited […]

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