SSI-Related Medicaid Programs
What is Medicaid?
Medicaid.gov describes it as: Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government.
In Florida, Medicaid is administered by the Agency for Health Care Administration [AHCA]. AHCA’ s role is to provide Floridians with health care information and information on the quality of care that they receive. AHCA is always looking for ways to improve health care and works with other agencies to achieve this. AHCA is also responsible for the licensure and regulation of Florida’s Health facilities.
The Florida Department of Children and Families [DCF] determines eligibility for Medicaid. DCF sets new limits for qualification each year. SSI-Related Financial Eligibility Standards: July 1, 2020. Medicaid eligibility is dependent on income, assets and medical need. An application is submitted to DCF including the individual’s income, their spouse’s, and all assets within the household. An overview of all Medicaid programs is available here.
Medicaid for the Aged (aged 65 or older) or Disabled, is considered SSI-Related Medicaid. SSI recipients are automatically eligible for Medicaid, through Social Security Administration [SSA]. All other individuals would need to qualify by applying for benefits through DCF.
In order to qualify, applicants must meet certain criteria. Some of the basic requirements include, but are not limited to:
- Must be a US Citizen or qualified non-citizen
- Must have a SS number
- Must provide proof of identification
- Must be a Florida resident
- Meet the SSI-Related income limit
- Meet the SSI-Related asset/resources limit
SSI-Related Medicaid Programs
Medicaid for Aged and Disabled (MEDS-AD): Medicaid for low-income individuals aged
65 or over or who are disabled.
Institutional Care Program (ICP): This program helps offset the costs of medical care for those individuals residing in nursing homes. Medical need is determined through a Level of Care assessment, administered through the Department of Elder Affairs.
Home and Community Based Services (HCBS): In lieu of long-term care placement in a nursing home, individuals are able to reside at home or an Assisted Living Facility, while still receiving medical care.
Program of All-Inclusive Care for the Elderly (PACE): Provides services to individuals in home and community based settings that meet a nursing home Level of Care.
Hospice: The Hospice Program helps maintain care for terminally ill individuals.
In addition to the aforementioned eligibility criteria, some of these programs may require additional eligibility qualifications. Individuals that exceed the income and asset limits, may still be eligible for such programs, however, additional documentation may be required of them.
Furthermore, DCF will do an asset verification within the last five years of the applicant’s date of application. This is considered the “the look-back period”. All finances within this timeframe will be assessed and reviewed by DCF. If something is in question, DCF will request further documentation. The five year look back period covers any assets that may have potentially been “gifted” away, in order to qualify for Medicaid benefits.
What is Medicaid Planning?
Medicaid planning takes into account that at some point in your life you may need to apply for Medicaid benefits. It considers your current estate planning, if any, and creates a plan to ensure that your assets are protected while affording the costs of long term care.
The Florida Supreme Court has declared that Florida Medicaid planning activities shall only be performed by an attorney licensed by the Florida Bar. As such, it is important you consult with a licensed Florida attorney to ensure you are represented properly when applying for Florida Medicaid.
The attorneys at our office are well equipped and experienced to create a specific plan tailored to your needs. Each case is reviewed on an individual basis. They craft a plan with you in mind according to your wishes and that which is in your best interest.
Call us today to schedule a free consultation. Call 561-588-7512 or 888-552-7512
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