Mainstreet Financial Education · Long-Term Care · Georgia 2026
Medicaid, not Medicare, pays for most nursing home care in this country. Here is what it covers, the 2026 Georgia income and asset limits, what the at-home spouse keeps, and why the five-year look-back makes early planning the whole game.
Families learn this distinction in a hospital hallway. Medicare covers up to 100 days of skilled nursing after a qualifying hospital stay, and only while daily skilled care is needed. It pays nothing for the custodial care that most people with dementia or frailty need for years. Medicaid does. It is the largest payer of nursing home care in the United States, and in Georgia it also funds care at home and in assisted living through waiver programs.
The trade is that Medicaid is needs-based. You qualify by having little income and few countable assets, and the state is repaid from your estate after death. For a family with modest savings, Medicaid is the plan. For a family with more, the question is how much of a lifetime of saving goes to care before Medicaid begins, and the answer depends almost entirely on how early the planning starts.
These are the figures for nursing home Medicaid and the home and community waiver programs. They change each January.
| Test | Single applicant | Married, one spouse applying |
|---|---|---|
| Monthly income limit | $2,982 | $2,982 for the applicant; the at-home spouse's income is not counted |
| Countable assets | $2,000 | $2,000 for the applicant, plus up to $162,660 kept by the at-home spouse |
| At-home spouse income allowance | n/a | Up to $4,066.50 a month can be shifted from the applicant to bring the at-home spouse up to that level |
| Home equity limit | $752,000 | No limit while a spouse lives there |
| Personal needs allowance | $70 a month | $70 a month |
| Look-back on transfers | 60 months | 60 months |
Georgia is an income-cap state. An applicant with income above $2,982 a month is not simply denied; the excess must be routed through a Qualified Income Trust, sometimes called a Miller trust, each month. An elder law attorney sets it up, and the nursing home receives the income either way. Nearly all of the applicant's income goes to the facility as the patient share, with Medicaid paying the rest.
The asset test looks at countable assets. These are the main things left out.
Any gift or transfer for less than fair value in the 60 months before applying creates a penalty: a period of months during which Medicaid will not pay, calculated by dividing the amount transferred by the state's average monthly nursing home cost. Giving the house to the children two years before a nursing home admission is the classic mistake. It does not shelter the house; it creates a penalty and the house is gone.
This is why the timing matters more than the technique. Planning done more than five years before care is needed is outside the look-back entirely. Planning done in a crisis is limited to a short list of lawful moves, such as spending down on exempt assets, paying off the mortgage, prepaying funeral costs, and spousal protections. An elder law attorney handles the legal work. My part is the financial side: which assets to spend first, what it does to the at-home spouse's income for the rest of her life, and whether long-term care coverage, a hybrid policy, or self-funding should carry the first years so Medicaid is a backstop rather than the plan.
A multi-year nursing home stay in metro Atlanta can run well past $100,000 a year. Medicaid pays it for as long as it is needed. No insurance policy and few savings accounts can say that.
The spousal rules exist so that one spouse's care does not leave the other destitute. The asset allowance, the income allowance, and the home exemption are all written for the spouse who stays home.
Georgia's waiver programs (CCSP and SOURCE) fund in-home help, adult day care, and assisted living for people who would otherwise need a facility. Slots are limited and there can be a wait, which is another reason to understand eligibility early. A family member other than a spouse can sometimes be the paid caregiver.
Qualifying means having spent or protected everything above the limits. For most families with real savings, the better plan uses Medicaid as the floor under a plan that pays for the first years another way, and keeps the choice of facility in the family's hands.
Medicaid planning is not about hiding money. It is about knowing the rules early enough that a family does not spend its last dollar on the first year of care and then discover the at-home spouse could have kept far more. If a parent is in their late seventies and you have not had this conversation, have it this year, with an elder law attorney in the room.
The look-back rewards families who ask five years early.
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