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How to Ensure Medicaid Eligibility in Florida

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    How to Ensure Medicaid Eligibility in Florida

    How to Ensure Medicaid Eligibility in Florida

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    Medicaid eligibility in Florida is notoriously complicated. With various strict income and asset requirements, many people fail to qualify for Long-Term Care (LTC) Programs in ways that could easily be avoided.

    As Elder Law attorneys, we regularly help people join the 4 million Floridians who are currently supported by Medicaid. This guide will help you understand how you, or the seniors in your life, can meet Medicaid eligibility in Florida.

    The information provided here is for introductory purposes only. Before making an application, please consult a Florida elder law attorney to ensure eligibility and avoid out-of-date information due to any recent changes.

    Requirements for Medicaid Eligibility in Florida

    As a senior in Florida, you may be able to qualify for one of the long-term care Medicaid programs. Each program has its own eligibility requirements, such as income, asset value and medical status.

    Read Related: Top Reasons Medicaid Applications Are Denied

    Status Requirements (2023)

    Anyone over the age of 65 or disabled is eligible to apply for Medicaid in Florida (as long as they meet the income and asset requirements).

    • A U.S. citizen or qualified alien;
    • Florida resident;
    • You cannot give away money or assets within 5 years of a Medicaid application. (However, charitable families or gifting may be still possible after specific measures are taken through careful estate planning).

    Types of Long-Term Care Medicaid in Florida:

    Type of LTC Medicaid Entitlement or Non Entitlement Use
    Nursing Home Medicaid Entitlement program for all who qualify. Providing assistance in nursing homes only, to anyone who is eligible
    Home and Community-Based Services (HCBS) Non-entitlement. Only accessible for a limited number of applicants, often involving a waiting list. Providing long-term care benefits at home, in adult day care, adult foster home and assisted living residences.

    Used to delay nursing home admissions.

    Regular Medicaid / Medicaid for Aged and Disabled (MEDS-AD) Entitlement program for all who qualify. Limited long-term health care services, like personal care.

    Eligibility Requirements for Long-Term Care Medicaid in Florida

    For Single Seniors

    Type of Medicaid Income Limit per month Asset Limit Level of Care Required
    Nursing Home Medicaid $2,742* $2,000 Nursing Home
    Home and Community-Based Services $2,742 $2,000 Nursing Home
    Regular Medicaid / MEDS-AD $1,084 $5,000 Help with Activities of Daily Living (ADLs)

    Married (With Both Spouses Applying)

    Type of Medicaid Income Limit per month Asset Limit Level of Care Required
    Nursing Home Medicaid $5,484 ($2,742 each)* $3,000 Nursing Home
    Home and Community-Based Services $5,484 ($2,742 each) $3,000 Nursing Home
    Regular Medicaid / MEDS-AD $1,460 $6,000 Help with Activities of Daily Living (ADLs)

    Married (With One Spouse Applying)

    Type of Medicaid Income Limit per month Asset Limit Level of Care Required
    Nursing Home Medicaid $2,742/month for applicant* $2,000 for applicants. $148,620 for the non-applicant. Nursing Home
    Home and Community-Based Services $2,742/month for applicant $2,000 for applicants. $148,620 for the non-applicant. Nursing Home
    Regular Medicaid / MEDS-AD $1,084/month for applicant $6,000 Help with Activities of Daily Living (ADLs)

    *The monthly income of a Nursing Home recipient must be paid to the nursing home, including: All of their income, minus a $130 monthly personal needs allowance, Medicare premiums and if applicable, a monthly maintenance needs allowance for the non-applicant spouse.

    Source: Benefits.gov

    What to Do If You Don’t Meet the Eligibility Requirements?

    If you or your senior loved one fails to meet the above-mentioned financial eligibility requirements, all is not lost. Through structuring and ‘spend-down’ programs, you can still qualify for Medicaid.

    1. Medically Needy Pathway

    Medicaid’s Medically Needy (MN) pathway is an alternative route to Medicaid eligibility in Florida, for people exceeding the income limit, but have high medical expenses. It is also referred to as the ‘Income Spend Down’ program.

    Put simply, a senior can spend their excess income on their medical expenses, such as health insurance costs, Medicare premiums and other medical bills.

    • In 2022, the medically needy income in Florida is $180 per month for single applicants and $241 per month for married couples.
    • The ‘spend-down’ amount will be the difference between your income and the medically needy income limit.
    • Once the ‘spend-down’ is met, eligibility is obtained for the remainder of the month.
    • Medically Needy Asset limit is $5,000 for individuals and $6,000 for couples.

    2. Spend Down Your Assets

    If your assets are over the limit for Medicaid eligibility in Florida, you can spend down your assets until you are eligible. We rarely recommend that an applicant do this to qualify.

    Spending down means spending excess assets on ‘non-countable’ ones. Non-countable assets are assets that Medicaid doesn’t count when determining eligibility, such as:

    • Home modifications
    • Wheelchair ramps or stair lift
    • One car of unlimited value
    • A second car, if it’s not a collectible car is over seven years old
    • Funeral plots
    • Irrevocable prepaid burial policies
    • Life insurance with less than $2,500 in face value.

    Note however that assets cannot be gifted or sold for under fair market value. Doing so would break the Medicaid look-back rule, resulting in a penalty period of Medicaid ineligibility.

    Before spending down, it’s advised that you contact a Florida elder law attorney to avoid making mistakes that result in penalties. You should also keep proof of how you spent your assets.

    3. Qualified Income Trusts (QITs)

    Qualified Income Trusts (QITS), also referred to as ‘Miller Trusts, provide a route to qualify for Medicaid even if your income exceeds the income eligibility rules.

    The applicant deposits money into the QIT each money to reduce their income down to meet the Medicaid eligibility criteria.

    These trusts are a type of irrevocable trust, so they can’t be changed or canceled once created. An appointed trustee will be named and legally responsible for the trust’s funds. The trust’s funds are often used for purposes such as medical bills, personal needs allowance and Medicare premiums.

    The State of Florida receives any money remaining in the trust, after the Medicaid recipient has passed away.

    4. Medicaid Planning

    Medicaid planning is another option for people who exceed the limits for Medicaid eligibility in Florida, but still cannot afford their cost of care out-of-pocket.

    You can utilize a variety of routes, such as trusts to restructure assets. The best way to do this is through a Medicaid planner or Florida Elder Law attorney.

    How to Apply for Florida Medicaid?

    If an applicant already meets the requirements for Medicaid eligibility in Florida, they usually turn to nursing homes or social workers for advice with the application process. Seniors still living at home can call the local Aging Resource Centre to be placed on the long-term care waiting list.

    If an applicant is above the eligibility criteria, then you will need to use an alternative strategy such as those listed above in this article. Contact a reputable Florida elder law attorney, so they can help you regain eligibility and ensure the application process is done flawlessly.

    Read Related: Why Use a Lawyer When Applying for Medicaid

    Hire an Elder Law Attorney in Riverview

    If you or a loved one needs assistance applying for Medicaid or has any questions, our Florida Medicaid planning lawyers can help. It’s advised that you take action sooner rather than later, as delaying can see you miss out on long-term planning opportunities.

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