What Does Medicaid In Georgia Cover
Generally, Medicaid covers the following services:
- Doctor and nurse office visits
- Lab tests and x-rays
- Outpatient hospital services
- Nursing homes
- Preventive dental care for children
- Certain emergency dental care for adults
- Non-emergency transportation to get to and from medical appointments
- Medical equipment and supplies prescribed by a doctor for use in your home
- Exams, immunizations , and all necessary treatments for children
- Family planning services
- Vision care for children
- Hearing services for children
If you are unsure about whether a particular procedure or service is covered by Medicaid, ask your doctor or pharmacist.
What If I Dont Meet The Eligibility Criteria
Georgia Medicaid has two pathways available to people who dont meet the income eligibility criteria. These are the Medically Needy Pathway and Qualified Income Trusts, also called Miller Trusts. In both cases, a person can spend down their excess income until it meets the Medicaid eligibility.
The Medically Needy Pathway allows income to be spent on medical bills. With Miller Trusts, excess income can be put in a trust so that the person meets the income limit. Money in the trust can be spent on a specific set of purposes, such as paying for long-term care or medical expenses. Upon the recipients death, money left in the trust will go to the state, up to the amount that the state had paid for care.
Neither of these pathways assists people who dont meet the asset limit, however. There are ways to spend down assets as well though. Modifying a home to improve accessibility, such as by adding ramps or a stairlift, are approved expenditures. People can also spend assets on home repairs, paying off debt or by purchasing a funeral trust. It is important not to transfer or sell assets for less than fair market value, as this can make an applicant ineligible for Medicaid for a period of time. Georgia Medicaid looks back five years at any transfers or sales of assets to determine if this has happened.
Financial Requirements In 2021
Applicants have a monthly income limit of $2,382 with a resource limit of $2,000. A couple, if both members need long term care, can have a resource limit of $3,000. If one spouse remains without long term care then the resource and income amounts go up considerably.
Amount of assets community spouse may retain: The maximum value of assets a community spouse can retain for self-support without disqualifying the nursing home spouse from eligibility is $130,380. If the community spouses assets do not equal a minimum of $130,380, he/she may be able to keep some of the nursing home spouses resources until the maximum is met.
Community spouse impoverishment protection: If the community spouses income does not equal at least $3,259.50 per month, he/she may keep some of the institutionalized spouses income in order to meet the limit.
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Georgia Long Term Care 2021
Georgia in 2021 is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application. In order for persons whose income exceeds the Maximum Income Limit to become eligible for Medicaid long-term care services, they can create a Qualified Income Trust, commonly known as a Miller Trust, for the excess income. To become eligible, the state must be named beneficiary on the Miller Trust.
Medicaid long term care in Georgia for 2021 allows seniors to live in whichever setting is most fitting for their situation. This could be a nursing home, the recipients own home, or a caregivers home. To be eligible, applicants must meet both income and asset limits, which may be different than other Medicaid programs they are currently enrolled in. Beyond economic factors, other deciding elements include functional status, age , citizenship, and Georgia residency status. Waiver recipients must qualify for the level of care given in a nursing facility or similar institutional setting. Listed below are the types of services covered in Georgia.
Where Can Medicare Beneficiaries Get Help In Georgia
Free volunteer Medicare counseling is available by contacting GeorgiaCares at 1-800-963-5337. This is Georgias State Health Insurance Assistance Program offered states Department of Human Services.
SHIPs can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. They may also be able to offer referrals to local agencies for services like home care and long-term care. This website has more information about GeorgiaCares.
Elder Law Attorneys
Elder law attorneys can help individuals plan for Medicaid long-term care benefits. You can use the National Academy of Elder Law Attorneys s search feature to find an elder attorney locally.
Georgias Long Term Care Ombudsman
Georgias Long Term Care Ombudsman helps beneficiaries understand their options for long-term care and investigates complaints made regarding a person who is receiving LTSS. Contact the Ombudsman Program by calling 552-4464. More information is available on the programs website.
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Georgia Medicaid Income Limit
The Georgia Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.
To qualify, you must meet the Georgia Medicaid Income limits listed below.
Here is the Federal Poverty Level for 2021.
|2021 Federal Poverty Levels for the 48 Contiguous States & D.C.|
Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:
- Children up to age 1 with family income up to 205 percent of FPL
- Any child age 1-5 with a family income up to 149 percent of FPL
- Children ages 6- 18 with family income up to 133 percent of FPL
- CHIP for children with family income up to 247 percent of FPL
- Pregnant women with family income up to 220 percent of FPL
- Parents of minor children with family income up to 32 percent of FPL
- Individuals who are elderly, blind, and disabled with family income up to 74% of the FPL
Who Can Get Medicaid In Georgia
You should apply for Medicaid if your income is low and you match one of the descriptions below:
- You think you are pregnant
- The parent or caretaker of a child and/or teenager under the age of 19.
- You are a child or teenager age 18 or under.
- An adult age 65 or older.
- You are legally blind.
- Living with a disability or disabled.
- You are in need of nursing home care.
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Georgia Medicaid Expansion Update
Georgia will partially expand Medicaid as of July 2021.
However, it will come with a work requirement and without the ACAs enhanced federal funding that would go along with full expansion.
In November 2019, the state unveiled an 1115 waiver proposal that calls for partial Medicaid expansion, effective in July 2021.
The partial expansion would cover adults age 19-64 with income up to 100 percent of the poverty level, as long as they work at least 80 hours per month.
The work requirement can also be fulfilled via various other community engagement activities, including job training, higher education, or community service.
However, there are time limits on vocational training and job readiness programs.
As of May 2020, 23 percent of people in Georgia did not have health insurance coverage.
Pregnancy / Womens Health Medicaid
Presumptive Eligibility Medicaid for Pregnant Women and Womens Health Medicaid
Q. Where do I go to apply for Medicaid?A. There are several ways to apply for Medicaid and other medical assistance programs:
- You can find out if you qualify for Medicaid or other medical assistance and social service programs by speaking with a representative at your local DFCS office. Call the DFCS information line at 877-423-4746 to be directed to the appropriate office where someone can help you. For a list of DFCS locations and address, phone, fax numbers in your county click the following link: www.dfcs.dhr.georgia.gov, click on County Offices, next click on Complete List of All County offices.
- To apply for Medicaid, you can submit a completed signed application online at Georgia Gateway, or you may print a Medicaid application and submit the completed signed application at any local DFCS office, in person, by mail, telephone, fax or email. Click on the following links to complete and print your application.
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Independent Care Waiver Program In 2021
ICWP offers services to people with specific physical disabilities, including people with traumatic brain injuries. Generally, this program is for people who are between the ages of 21-64 and are severely disabled. The services include personal support, emergency response, home health, counseling, home modifications , and affordable access to medical equipment or supplies.
How Does Medicaid Provide Financial Help To Medicare Beneficiaries In Georgia
Many Medicare beneficiaries receive assistance from Medicaid with Medicare premiums, prescription drug costs, and expenses not covered by Medicare including long-term care.
Our guide to financial assistance for Medicare enrollees in Georgia includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.
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How Does Georgia Regulate Long
Medicare beneficiaries increasingly rely on long-term services and supports or long-term care which is mostly not covered by Medicare. In fact, 20 percent of Medicare beneficiaries living at home received some assistance with LTSS in 2015, and the portion of seniors needing those services will keep increasing as the population ages. Medicaid fills the gap in Medicare coverage for long-term care, but its complex eligibility rules can make qualifying for benefits difficult. Whats more eligibility rules vary significantly from state to state.
Georgia uses a special income limit for Medicaid nursing home benefits and HCBS. This limit is 300 percent of the Supplemental Security Income payment amount or $2,349 a month per applicant.
Medicaid nursing home coverage
Most seniors used to receive long-term care in nursing homes. Today, many Americans receive those services in their homes. But medical conditions or living situations can make nursing home care a better choice for some.
Income limits: The income limit is $2,349 a month if single and $4,698 a month if married . When only one spouse needs Medicaid, the income limit for single applicants is used and many states only count applying spouses income toward the eligibility limit.
Assets limits: The asset limit is $2,000 if single and $3,000 if married . If only one spouse needs Medicaid, the other spouse is allowed to keep up to $128,640.
Home and Community Based Services waivers
Permitted home value in Georgia
What Is Covered By Georgia Medicaid
Medicaid in Georgia covers a wide range of services that support the health of its beneficiaries. This includes doctors office expenses, diagnostics, hospital visits and dental treatments. Prescription drugs that are used to cure or treat a medical problem are also covered. For example, insulin or antibiotics are covered but not drugs for hair growth.
Waiver programs are used to cover additional services. All waiver programs in Georgia include care coordination, personal support for daily living activities, home health services, emergency response systems and respite care. Additional services are available under each program but may differ based on the enrollee. Nursing home care is also covered by Medicaid in Georgia.
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Georgia Medicaid Eligibility And Enrollment
- Thinking about applying for Medicaid in Georgia? Get essential information about the program’s availability, coverage, who’s eligible and how to apply.
Older Georgian residents that find themselves struggling with medical bills may be able to get assistance through Georgia Medicaid. As of September 2020, more than 2 million people have enrolled in Medicaid and CHIP, a number that has grown by 30% since 2013, when targeted enrollment strategies were adopted. People wishing to enroll in Medicaid must meet certain eligibility criteria in order to gain access to the wide range of benefits. These benefits may help them obtain needed medical treatments and age independently.
Ccsp & Source Alternative Living Services Manual January 2020
Generally people utilizing the CCSP Program through Georgia Health Services are elderly and unable to live alone. They do not need the level of care found in a nursing home but do require some assistance with everyday living. CCSP recipients have a monthly income between $400 and $1809 per month.
Persons served through the CCSP Program must be eligible for Medicaid and meet the following requirements:
- Have cognitive and or physical impairments/limitations which make it difficult to perform normal daily living activities and live independently
- Have health needs that can be met in the community with services offered by the program and within established individual cost guidelines.
What does this mean? If your loved one has Medicaid , meets the above criteria, and has an income less than $1900 dollars per month, they may qualify for the CCSP or SOURCE Program and obtain residency in a licensed personal care home.
How much does it cost? Residents using CCSP pay the personal care home $660 per month and a cost share determined by a CCSP Staff Member.
Why do we have to pay a Cost Share? Cost Shares are used to offset the amount not paid by the State of Georgia for ALS Services. CCSP and DFCS determine the cost share.
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Georgia Medicaid Income Limits Summary
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Medicaid Spending In Georgia
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|Medicaid spending in Georgia|
Georgia’sMedicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children’s Health Insurance Program , which covers low-income children above the poverty line and is sometimes operated in conjunction with a state’s Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.
This page provides information about Medicaid in Georgia, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.
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Did Georgia Accept Medicaid Expansion
No, the state of Georgia of the 14 states that have not expanded Medicaid coverage to low-income adults.
That means that about 726,000 adults with low income who would otherwise be covered by Medicaid expansion are left without coverage.
Without Medicaid expansion in Georgia, some 240,000 people have no realistic access to health insurance.
Medically Needy Program Limits
In states with Medically Needy Medicaid programs, individuals may qualify for Medicaid if they have medical expenses that significantly reduce their income.
The Georgia Medically Needy Program has no income maximum. In other words, individuals are allowed to use medical expenses to spend down the difference between their income and the medically needy income level .
The Medically Needy calculation is completed on a monthly basis and only pays for medical bills incurred after the spend-down is met.
Medically Needy Program for Pregnant Women
For Adults that are Elderly, Blind or Disabled, the MNIL is $317 for an individual and $375 for a couple. For reference, Medically Needy is calculated on a monthly basis and only pays for medical bills incurred after the spend-down is met.
Medically Needy Program for Adults
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Georgias History With Medicaid Expansion
As of May 2020, 23% of Georgia residents were uninsured the state has the fourth highest uninsured rate in the U.S. Georgia is leaving billions of dollars on the table and over half a million people without Medicaid coverage by passing up federal funding to expand Medicaid.
Two laws designed to make expansion difficult were enacted during the 2014 legislative session. HB 990 prohibits Medicaid expansion without legislative approval , while HB 943 prohibits state and local employees from advocating for Medicaid expansion.
By the spring of 2016, Medicaid expansion began to seem within reach in Georgia, fueled in part by support from hospitals facing severe financial challenges. The state has raised Medicaid reimbursement rates for providers, including OB-GYNs in the state, in an effort to keep providers solvent and able to accept Medicaid patients. And Republican lawmakers began indicating that they might be open to a privatized version of Medicaid expansion, like the model used in Arkansas.
However, there was no real progress on Medicaid expansion in Georgia until the partial expansion proposal was announced in 2019. Governor Brian Kemp, who took office in 2019, has been steadfastly opposed to full Medicaid expansion, although he views the Georgia Pathways program as a conservative compromise aimed at helping people who are working but not able to afford health coverage.