Florida Seniors’ Guide to Medicaid Services and Eligibility
Florida 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.
Florida implemented a new system for long term care services through Medicaid. The program is called the Statewide Medicaid Managed Care Long-Term Care Program.
Medicaid for Aged and Disabled (MEDS-AD)
- The MEDS-AD Program entitles eligible aged or disabled individuals to receive full Medicaid coverage.
- This program does NOT cover blind individuals unless they are considered disabled.
- Individuals cannot receive Medicare Part A or B unless the individual receives ICP, Hospice, or Home and Community Based Services (HCBS) Waiver.
(If nursing facility care is required, the individual must meet the additional eligibility requirements for ICP.)
Institutional Care Program (ICP)
- The Institutional Care Program (ICP) helps people in nursing facilities pay for the cost of their care and provides general medical coverage.
- Must need of nursing facility services and appropriate placement as determined by the Department of Elder Affairs (DOEA), must meet requirements as defined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES).
1. Residency and Citizenship – the applicant must be a resident of Florida and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 300% the Federal Benefit Level ($2,199) to become eligible for Medicaid. Persons with income in excess of $2,199 can still qualify for Medicaid coverage if excess income is placed into a Qualifying Income Trust (QIT). The trust must be irrevocable and Florida must be the designated recipient when the beneficiary dies. Only income in excess of $2,199 must be placed in the trust.
- A personal needs allowance of $35/month is not factored into the total countable income.
- Florida is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets for an applicant in Florida include:
i. $2,000 or less in cash/non-exempt assets if single. If married and both spouses require nursing level care the resource limit is raised to $3,000.
ii. One home is exempt (equity limit $552,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Irrevocable burial trust, no amount specified.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $119,220.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $1,966. The maximum amount of income that can be retained is $2,981 varying by case, depending on unique living expenses.
Florida long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
SSI-Related Medicaid Programs Fact Sheet- http://www.dcf.state.fl.us/programs/access/docs/ssifactsheet.pdf