The following Georgia Medicaid cases were litigated outside the context of an administrative hearing, or were appealed beyond that point. Of course, we are not representing there are no other published decisions on point. United Cerebral Palsy of Georgia v. Ga. Dep’t of Behavioral Health and Dev. Disabilities, 331 Ga. App. 616 (2015). A provider […]
On May 4, 2023, the Department of Community Health announced the new state-wide average nursing facility private pay rate increased from $9,034.00 to $9,584.00. This rate is the divisor when calculating the length of a transfer penalty when resources or income are transferred for less than fair market value.
When applying for Medicaid, the nursing home spouse (called the Institutionalized Spouse) is often a joint owner (or sole owner) on checking, savings and other acounts. Should those resource be taken out of the name of the Institutionalized Spouse? The answer is generally “yes,” but it requires some context and some qualifications. The context and […]
Some couples might consider reducing the size of the marital estate by giving their resources away. Frequently this is the result when the plan is “home-made.” However, transfers for less than fair market value, including complete and partial gifts) trigger a period of ineligibility. 42 U.S.C. 1396p(c). It does not matter whether the applicant or […]
If you agree to file a client’s Medicaid application as part of your representation, here are a few practical considerations. Keep in mind, these suggestions are how we handle matters in our office. If you have a different approach, that’s fine. If you have suggestions on other ways to approach applications, we’d love to hear […]
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 […]
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 […]
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 […]
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:
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 […]
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