Many people over the age of 65 will need some type of long-term care at some point in their lives. The cost of long-term care can be extremely expensive, and, in Florida, the average monthly costs can run between $6,000 and $8,000. This means that everything you may have been able to save in your lifetime can evaporate very quickly; therefore, it is important to speak with a lawyer knowledgeable about Florida Medicaid planning.
What is Medicaid?
Medicaid is a state and federal program that assists people with healthcare costs who have low incomes and minimal resources. Medicaid should not be confused with Medicare; the latter is an insurance program only for people over the age of 65, whereas Medicaid is a federal insurance program that covers healthcare for people of all ages with low incomes. Medicaid also covers benefits not covered by Medicare and these benefits include personal care services and nursing home care.
The important thing to understand is that to qualify for Medicaid benefits, seniors need to show that they have limited assets and income limitations. If you are about to retire, then a consultation with an experienced lawyer is recommended as he or she can assist you in learning how you might qualify for Medicaid benefits, while at the same time helping to preserve as many of your assets as possible.
Medicaid Rules
In general, Medicaid is designed to provide healthcare coverage to those who have limited income, including children, individuals with disabilities, and pregnant women. To be eligible for Medicaid, one has to be a U.S. citizen. The government determines eligibility for Medicaid based on income that is proportional to the size of the family. For seniors to qualify for Medicaid, there is an asset limit of $2,000 for those who are single and $3,000 if married. Many seniors, however, have assets that amount to more than that. Some seniors may have a home and others may have investments – so how does one qualify for Medicaid?
- When determining Medicaid eligibility, it is important to understand that not all assets owned by seniors are included in the assessment. For example, your car and home can be exempt.
- Further, for seniors who are still married, the spouse is permitted to have specific assets that are not used to determine eligibility for Medicaid.
In the State of Florida, the requirements do change whether you are a single person or married. Florida Medicaid planning offers guidance to help determine your eligibility. Florida is unique in its “Homestead” laws, which include the fact that, if you go on Medicaid, your home is allowed to remain your home, as long as a few criteria are met.
What is Florida Medicaid Planning?
In Florida, three categories are utilized for eligibility:
- Institutional or Nursing Home Medicaid
- Home and Community-Based Services (HCBS)
- Regular Medicaid
Institutional or Nursing Home Medicaid is available to all those who are eligible and in need of nursing home care.
Home and Community-Based Services (HCBS) support long-term care services that are provided in the home, at assisted living residences that have a managed care system, adult foster care, or adult day care homes. This Florida program utilizes one agency that takes care of all these types of long-term care needs.
In the past, Florida offered “HCBS Medicaid waivers” but those are no longer available. Like those waivers, this managed care program limits the number of participants to space that is available to them and, therefore, there could be a waiting list for these services.
Regular Medicaid in Florida is described as for the “Aged and Disabled (MEDS-AD)” and is available to all those who are eligible for the services. With this program, benefits are either provided in a home or adult daycare setting. The asset limits for Regular Medicaid are either $5,000 (single) or $6,000 (married) but there has to be no level of care that is required.
Planning for Medicaid Services
Medicaid planning usually involves considering the welfare of both senior partners. One spouse may be attempting to qualify for Medicaid so that the cost of long-term nursing care is paid, and the other partner may still be healthy and prefers independent living at home. Here are some facts about Medicaid eligibility that may be helpful:
- First, the rules and regulations for Medicaid eligibility vary from state to state. Just because one senior may be ineligible for Medicaid does not mean the other will also be ineligible.
- Every Medicaid application has to have solid documentation as to why the senior needs Medicaid and has proof that his assets are less than $2000 if single and $3,000 if married.
- If the senior can show that he or she spends an enormous amount of money on healthcare expenses, then one can become eligible for Medicaid.
Medicaid Planning Forms
The eligibility rules for Medicaid can be complex and confusing, and that is why a lawyer is often called upon to help. All seniors who apply for Medicaid benefits to cover the costs of a nursing home are required to complete the Medicaid Long Term application, in addition to the Medicaid application.
This form will require the senior to disclose all income and assets, and what has been given away over the past five years. For example, if a senior wants to become eligible for Medicaid, he or she simply cannot transfer all the assets to children or a relative. Medicaid does a thorough background check to ensure that no transfers have been made in the past five years.
Florida Medicaid Income Limits 2021
Several assets can be considered exempt from Medicaid’s calculations as to who is eligible to receive benefits. These include the primary home (considered a homestead in Florida), personal belongings, a car, irrevocable burial trusts, and household furnishings. To have the home considered exempt, the applicant needs to prove that he/she lives in it or plans to return to it.
Also, that his/her equity in the home does not exceed $603,000 (2021 figure). If the applicant is married and the spouse continues to live in the home, it is exempt regardless.
The Florida Medicaid income limits 2021 state that the non-applicant spouse can keep, to a maximum, $130,380 of the assets shared jointly. Medicaid calls this the Community Spouse Resource Allowance (CSRA).
How Do You Know If You Qualify For Medicaid?
The best way to know if you are eligible for Medicaid is to first consult with a Florida Medicaid attorney who is familiar with elder law. The earlier you start, the more you will be prepared and be able to make an informed decision. In addition, you will also realize you have several options, including a combination of Medicaid funding and long-term care insurance, to help cover the long-term nursing home care costs.
Can You Qualify For Medicaid If You Have Assets Over the Limits?
You really need an attorney who is knowledgeable about Medicaid to help guide you through the processes of learning everything there is to know about Florida Medicaid planning. As stated above, it can be complex and confusing. There are three ways you still may be able to qualify for Medicaid even if you are over the asset limits. They include the following:
Medically Needy – If healthcare/Medicare premiums and health insurance costs have exacted too high a toll, even if you are over the qualifying limits, you still may be able to qualify for Medicaid. This is also sometimes referred to as a “spend down” program. In this case, the individual would be able to spend any excess income on medical bills and expenses until they have “spent down” to the required Medicaid eligibility limit.
Qualified Income Trusts (QITs) – QITs allow individuals to put excess income (over the qualified Medicaid limit) into a “trust”, whereby that money can only be used for qualified and specific purposes. A trustee must be named to control the money, and a QIT is irrevocable – it cannot be canceled.
Medicaid Planning – Many people exceed Medicaid’s qualifying limits, but still are unable to afford the costs of healthcare. Florida Medicaid planning with the assistance of an experienced attorney can help families determine a strategy that will meet their needs best, while still protecting their home and car.
The best strategy for maximizing your resources and also maximizing the healthcare assistance you need is by Florida Medicaid planning with a knowledgeable elder care lawyer, such as at Elder Law. Call today to set up an appointment.
