Am I eligible for Medicaid in Florida? Like Medicare, Medicaid is a federal program that was established more than 50 years ago to help cover the healthcare costs of Americans with disabilities, those with low income, and disadvantaged children.
Over the years, the Medicaid program has undergone several revisions, but the underlying premise remains the same. It is a health benefits program for the poor and those who are not able to work for whatever reason.
Florida Medicaid is often referred to as the Statewide Medicaid Managed Care program. A subdivision of Medicaid also offers long-term care services for the disabled and elderly.
Outside of long-term care services, the rest of the Medicaid healthcare services are run by the Managed Medical Assistance program. The Florida Agency for Health Care Administration is responsible for administering Florida’s Medicaid program.
Who qualifies for Medicaid in Florida? Issues arise for potential Medicaid recipients due to the stringency of eligibility criteria.
Even though there are many rules and regulations, each case is independently reviewed, and the program looks at many other factors in the applicant’s life before making a final decision. No two cases are alike. Because the requirements vary, it is important to consult with an attorney who is experienced in dealing with the Medicaid processes in Florida.
Who Qualifies for Medicaid in Florida?
- You must be a full-time resident of Florida.
- You must show evidence that you need healthcare insurance or that you have a medical condition(s) that need(s) treatment. This evidence/documentation must be from a licensed healthcare provider.
- You must show your financial condition and prove to Medicaid that you have a low income. This includes showing your tax forms over the past few years, all your bank accounts, investments, and if any property or vehicle is owned.
- You must be an American citizen or show proof of legal U.S. immigration status.
- Be age 64 or older if you are applying for long-term care services.
- Be pregnant or have a child under the age of 18.
- Have a physical disability, such as blindness, paralysis, etc.
- Have a family member (e.g., parent, child, or spouse) in the home who is disabled, paralyzed, or blind.
Institutional Care Program
Every state, including Florida, has Institutional Medicaid, a minor program under Medicaid which pays the cost of nursing or long-term care. The program pays for the cost of room and board, personal and nursing care, and miscellaneous therapeutic services.
If a senior has already qualified to receive Institutional Medicaid, the state will pay the difference between the nursing home’s monthly cost and the individual’s monthly income.
Am I Eligible for Medicaid in Florida?
Florida Medicaid operates several types of benefit programs in the state, and each has different criteria for eligibility and qualifications. No matter which program you apply to, you have to meet the financial requirements and, secondly, show that you’re in need of medical care or require long-term nursing care.
What Will Medicaid cover?
If you are eligible for Medicaid in Florida, the program will cover the following:
- Healthcare expenses for visiting physicians
- Inpatient hospital treatment
- Screening tests
- Skilled nursing care and home health services
- Laboratory tests and X-rays
- Birthing
- Transportation to health clinics
- Selected prescription services
- Rehabilitation
- Long-term nursing care for seniors with low income
Health Requirements for Medicaid
Who qualifies for Medicaid in Florida? Other than income requirements, one also has to meet certain health requirements to be eligible for Medicaid. The following documentation will be needed from licensed healthcare professionals:
- Your disability or chronic disease
- All comorbidities
- The present treatment for your disorders
- How much care you will need and what type of care. Medicaid will want to know if the senior requires care 24/7, only during the day, or only for daily living activities.
- The individual must show a need for a nursing home level of care, meaning that he or she needs help with all daily living activities and constant monitoring. Simply going to a nursing home for other personal reasons is usually not covered by Medicaid.
- A thorough medical exam or health screening has to be completed by a licensed physician to validate the claim for nursing home care.
Financial Resources
Medicaid was designed to help people with low income and no other financial resources. Therefore, the individual applying for benefits has to show that he or she doesn’t have the financial means to pay for any healthcare expenses. Medicaid will perform a thorough audit of the individual’s financial status.
If the individual has a high monthly income or has valuable assets that do not meet Medicaid eligibility requirements, then you have the option of restructuring your finances with the help of a Medicaid attorney or paying for your own medical expenses.
Income Requirements
Am I eligible for Medicaid in Florida? In addition to any assets, Medicaid will also consider the applicant’s monthly income to determine eligibility for benefits. Any money earned regularly on a month-to-month basis is considered income by Medicaid.
As of January 2021, Florida Medicaid has an income cap of $2,382; if the applicant earns above that, he or she is not eligible. However, married applicants with a partner can maintain part of their income without it being counted against the income cap, dependent upon the amounts.
What Does Medicaid Define as Countable Assets?
According to Medicaid, countable assets include the following:
- Cash
- Checking accounts
- Bonds
- Stocks
- Credit union savings
- Investments
- Real estate (not the one where the senior resides)
Non-countable Assets
- Household furnishings
- Personal belongings (not to include art collections or valuable jewelry)
- Personal car
- Burial trusts
- The primary residence as long as the applicant has an intent to return to it or has a spouse or child living there.
- Home equity should not be more than $603,000. However, if the community spouse and/or a child under age 21 resides in the home, the home is exempt.
- As of January 2021, if the couple is married, the community spouse can retain up to a maximum of $130,380 of the couple’s assets.
The “Look Back” Period
All applicants to Medicaid should be aware that the agency does have a look-back period where it will look for any assets or finances that were given away over the previous five years. If the individual gave away the assets just to qualify for Medicaid, he or she can be disqualified, penalized, and/or charged with fraud.
How to Apply to Florida Medicaid
Individuals who wish to apply for Florida Medicaid can go on the ACCESS website where they can get additional information and assistance with the application or call the Florida Medicaid phone line at 1 866 762 2237.
It is advisable to have the assistance of a knowledgeable Medicaid attorney to help with filing the application. It can be a complex and intricate process to navigate the Medicaid system. It will go smoother if you have the helpful assistance of a lawyer specializing in elder care needs.
Medicaid Planning
Am I eligible for Medicaid in Florida? If you are planning to apply for Medicaid, you need to create a plan to protect your assets and also improve your chances of qualifying for Medicaid. Without any planning, the chances of getting rejected by Medicaid are higher. Also, if you enter any false information regarding your income or assets, even if it is accidental or unintentional, you can face penalties.
Medicaid planning is not something to be done hastily, but, rather, it takes time to prepare as all the documents have to be in order, and the income and financial requirements have to fall under the cap set by Medicaid. An experienced Medicaid attorney can help restructure your assets legally so that you can meet eligibility requirements for Medicaid. Call the experts at Elder Law, P.A. today at (561) 588-7512 for a free consultation.
