Four consolidated appeals addressed Georgia's Medicaid asset-transfer penalty for annuities purchased for married applicants seeking long-term-care benefits. The Department of Community Health treated each annuity as a disqualifying transfer because the purchaser had not named the State as a remainder beneficiary. The Georgia Court of Appeals held that federal Medicaid law requires that designation for annuities benefiting a community spouse, because those annuities are treated as transferred assets. But the court distinguished annuities benefiting the institutionalized spouse that satisfy the federal statute's protections for certain irrevocable, nonassignable, and actuarially sound instruments. Georgia's Medicaid Manual improperly required the State designation even for those protected annuities. The court therefore reversed the ruling against Glover, whose annuity benefited the institutionalized spouse and met the statutory requirements. It upheld the agency rulings against Bottesch, Shorey, and Robertson because their annuities benefited community spouses or otherwise fell within the transfer-penalty provision. The court held that the manual could not override the federal statute's plain text and reversed the superior-court judgments in all four cases.