Cost-share deduction for health insurance premiums. The ALJ stated the issue as whether a nursing home resident is entitled to a deduction from her patient liability for Medicaid for Health insurance premiums paid by her spouse who resides in the community. DFCS disallowed IME coverage for health insurance premiums paid y the Community Spouse, taking […]
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The Limit is the Limit. An 84 year old applicant was denied Medicaid for the months of December 2007 through February 2008. She had sold her home in August and after paying debt, used the remaining $18,686 in equity paying for nursing home care until she ran out of funds in December 2007. Her son […]
Where application was lost, eligibility retroactive eligibility related back three months from date of original application. After receiving a personal injury settlement in May 2007, Petitioner was ineligible for Medicaid until she spent down. She spent down before July 1, 2007, reapplying for Medicaid by hand delivery on October 30, 2007. Petitioner did not receive […]
DFCS directed to determine eligibility where application was pending for over one year. Petitioner filed an application for Medicaid on May 22, 2007. On June 18, 2007, a verification package was given to Petitioner’s daughter. On July 1, 2007, the application was denied for failure to provide verification. On July 25, 2007, Petitioner requested a […]
Sole Benefit Trust rejected and transfer penalty imposed. An 86 year old applicant established an irrevocable trust for the benefit of his 64 year old daughter. However, the trust was not submitted to DCH Legal for approval and Petitioner submitted no evidence that the trust comported with Section 2346 relating to special needs trusts. Further, the […]
Transfer Penalty Reversed Where Home Was Returned. Three months prior to a nursing home admission, a 98 year old Petitioner purchased her daughters home for $406,300, plus personal property valued at $26,775. She paid by transferring securities valued at $484,766.78, and $51,691.78 was returned to Petitioner as an over-payment. Petitioner’s alleged hope was that she […]
Incorrect Decision Reached Regarding Status of Community Spouse. A nursing home resident’s spouse was denied a Community Spouse Monthly Income Allowance when she moved to the Philippines after her husband was admitted to a nursing home. She was attempting to secure a visa to return to the U.S. at the time of the hearing and […]
Georgia’s Medicaid Manual cannot be enforced when it conflicts with federal law. Applicant resided in an assisted living facility until she went to a nursing home in 2008 and applied for Medicaid. Prior to that time, her vacant home was placed on the market and sold. To accomplish the sale, Petitioner conveyed her life estate […]
Ignorance of QIT Requirement Does Not Excuse Failure to Comply. Nursing home resident’s son assisted with her October 25, 2007 Medicaid application. At the intake interview on November 7, 2007, he disclosed that he opened a QIT with $50. He did not fund it further by transferring her excess income into the trust until that […]
Assessment of transfer penalty on sale of life estate affirmed. Conservators sold life estate for $1,500, then sold the applicant’s home for $55,000 after putting $13,397 into repairing the home. A transfer of resource penalty was assessed because the life estate interest was .58914 percent of the home value, which is well below $1,500. On […]
