Florida Medicaid funds a number of programs for seniors who may need long-term care, assisted living, or nursing home care. All the Medicaid eligibility requirements in Florida programs slightly differ when it comes to criteria for eligibility. But, in each case, to qualify for Florida Medicaid assistance, one has to meet the income and asset cap criteria. Just because you have several assets, however, doesn’t always mean that you will be disqualified from Medicaid. The agency does differentiate between assets that are countable and those that aren’t. For example, Medicaid allows applicants to own one car, but if the senior has one luxury new car and an RV, these are countable assets and above the asset limit. Another senior, however, may have two old cars — one of which is used to transport his handicapped son to the doctor’s office regularly. In this case, Medicaid will not consider the second car to be a countable asset. Similarly, when it comes to Florida Medicaid income limits 2021, the eligibility criteria depend on whether you are single or married, and what type of Medicaid program you are applying for.
- Nursing home or institutional Medicaid is available to anyone who meets the eligibility criteria, and the benefits are only provided while one is at the nursing home.
- Home and Community Based services offer care at home, assisted living residences, and adult daycare. These services are available through a managed care system via a single administering agency. However, this program has a limit on the number of applicants and there is a long waiting list, even for those who meet the qualifying criteria.
- Regular Medicaid for Aged and Disabled (MEDS-AD) is a program that offers services at an adult day care or home. Once the individual meets the eligibility requirements, the services are fully provided.
Seniors who wish to know if they are eligible for Medicaid benefits can take the Medicaid eligibility test. It is important to be aware, however, that not meeting the eligibility criteria does not mean you still cannot qualify for Medicaid. Because there are so many variables, it is important to consult with an experienced Medicaid lawyer who can evaluate your case and determine if you meet the Medicaid eligibility requirements in Florida.
FLORIDA MEDICAID INCOME LIMITS 2021
Florida is an “Income Cap State,” which means that if an individual’s gross income is more than $2,523 per month, that person is not eligible for Medicaid assistance. The Florida Medicaid income limits are reviewed as the gross amount of income, which means that insurance premiums, tax deductions, and Medicare Part B premiums have to be included in that total.
What does Medicaid Define as “Income?”
When trying to meet Medicaid eligibility requirements Florida criteria, any income that the applicant receives is countable, and this income can be derived from any source. For example, all salaries, pensions, alimony payments, Social Security income, disability income, stock dividend, and IRA withdrawals are considered countable incomes by Medicaid. However, for instance, the Covid-19 stimulus checks are not counted towards eligibility. You should be aware that Medicaid will perform a thorough search to ensure that you have reported all your income; failure to do so could result in disqualification from Medicaid, as well as a monetary penalty.
If only one spouse is applying for home and community service or Institutional Medicaid, then only the applicant’s income is counted. This means that the community spouse’s (considered the well spouse) income is not factored into the eligibility criteria. If the applicant is applying for regular Medicaid, however, the incomes of both spouses count toward Medicaid eligibility.
Minimum Monthly Maintenance Needs Allowance (MMMNA): If one spouse is applying for home and community services or institutional Medicaid, then the community spouse is entitled to MMMNA; as of July 2021, this was equal to $2,177.50 a month. This ruling means that the applicant is permitted to transfer some of his/her income to the community spouse to live on. The significance of this is that the community spouse is not left without any money. But this rule does not apply when one applies for regular Medicaid services, which means that the Medicaid applicant cannot transfer his or her income to the community spouse.
After the deduction for the monthly allowance for the community spouse and a personal allowance ($130 a month), the rest of the recipient’s income must be used to pay towards the cost of the nursing home care services.
What does Medicaid define as “Assets?”
According to Medicaid, countable assets include the following:
- Credit union savings
- All checking and savings accounts
- Home(s) in which one does not reside. In general, the applicant is only permitted to have one home. In Florida, it is referred to as the “homestead.”
For Medicaid eligibility, there are many non-countable assets which include the following:
- Home furnishings
- Personal belongings
- One vehicle; a second one is allowed as long as it is older than seven years
- Irrevocable burial plans for the individual and family members
Medicaid does not count the residence as a countable asset if the applicant or the spouse is living in it or if the applicant plans to return to the home after treatment. In addition, the home equity should not be more than $603K. This does not apply as long as the spouse is residing in the home.
If the couple is married, and if one of them is applying for home and community-based services, the community spouse (aka well spouse) can retain up to a maximum of $130,380 of the couple’s joint assets. However, this community spouse resource allowance does not apply when an application is made for regular Medicaid benefits.
The “look-back” Period
All applicants for Medicaid benefits should be aware that Medicaid does have a five-year look-back period from the time of the application. During the look-back timeframe, the agency goes over all the assets and income to ensure that the applicant did not give away the money to friends or family. If any irregularity is discovered, the individual is disqualified from Medicaid and can be subject to heavy monetary penalties.
Need for Care
All seniors applying for Medicaid benefits must have formal documentation of their needs from a licensed healthcare provider. This cannot be any doctor or nurse; it has to be someone who has followed the senior for several years and is aware of the functional limitations. The letter should document what disability the senior has, the prognosis, what type of nursing care is required, and for how long. In some cases, the caregiver may need a break from providing care to her or her spouse and may need respite care. The doctor can state the need for respite care or even additional supervision if there is a need.
The countable and non-countable assets, according to Medicaid, are not written in stone and each case is judged by its merits. Because the application for Medicaid benefits is not straightforward, it is highly recommended that you consult with an experienced Medicaid attorney. An experienced lawyer cannot only provide you with legal guidance but help you with the Medicaid application. More importantly, if you have assets and income above the Florida Medicaid income limits 2021 cap, the attorney can recommend legal maneuvers to redistribute your money so that you can hopefully meet the Medicaid eligibility requirements Florida qualifying criteria. Call a Florida Medicaid Attorney today at 561-588-7512 to learn more.