Medicaid Book – Georgia

Medicaid matters to elders and individuals with special needs because it is the only government program providing substantial help paying for significant long-term care. Yes, some long-term care is paid for by Medicare, but only when there is a skilled need, and usually limited to no more than 100 days. Although anyone accessing this website can view The Medicaid Book, it is primarily intended for attorneys and other professionals interested in understanding Medicaid. We have other pages on this website written in more general terms for non-attorneys. These materials are presently being updated and chapters will be published as they become available. Once that is done, we will attempt to keep them as current as possible. If you have any questions, suggestions or corrections regarding the content, please refer them to david@ezelderlaw.com.

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Medicaid: Georgia’s Medicaid Lien Attaches to Entire Recovery

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 Round-up – October 5, 2021

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 […]

Medicaid: Deeming Terminates After Eligibility is Established

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 […]

Medicaid: Homeplace Exemption

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 […]

Medicaid: Pooled Trust Subaccount Established for Individual Over 65

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 […]

Medicaid: No Penalty on Transfer to Disabled Child; Previously Unknown Resource Exempt

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 […]

Medicaid: Annuity; Transfer Penalty for Failing to Name State as Beneficiary

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 […]

Medicaid: Single Premium Life Insurance Policy; Penalty Reversed

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 […]

Medicaid: No Retroactive Application of Policy Changes Permitted; Payments for Renovations to Accommodate Petitioner Permitted; Payments Consistent with Prior Accepted Obligation Permitted

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 […]

Medicaid: Personal Services Contract Rejected

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. The […]

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