Unlike Medicare, Medicaid does have a program that pays for some or all the costs for long-term care for seniors. A Florida Medicaid attorney can provide invaluable assistance. To qualify for the Florida long-term Medicaid program, you must meet certain medical eligibility requirements Florida, which include the following:
The applicant or senior must first show that there is a medical need or needs care in a long-term nursing home. The first step is to see a healthcare provider (usually a physician) and have it documented that you are not able to stay at home independently or cannot look after yourself. If there are any other combined illnesses or diseases, such as dementia, Alzheimer’s disease, cancer, disability, paralysis, etc., they should be documented.
The doctor has to state why you need long-term care assistance and what type of assistance. The letter must come from a doctor who has followed your health for at least 6-12 months to know the progression of his or her disease and future prognosis. A letter from a doctor that the senior has never visited before will not do. In addition, if there are any other physical or mental deficits, other specialists like the neurologist, physical therapist, social worker, or rehabilitation specialist should provide documentation; this makes the application bona fide.
The second requirement is meeting Medicaid asset limits (see below).
The third requirement is meeting Medicaid income limits (see below).
For the senior to become eligible for Medicaid benefits, he or she has to meet all three of the above requirements.
What Happens if the Senior Does Not Meet the Above Medicaid Requirements for Long-Term Care Benefits?
If the senior does not meet the asset limits or income limits requirements for Medicaid, the best advice is to consult with an attorney knowledgeable with Medicaid rules and practices, who can help you with Medicaid planning. This basically means that the lawyer can help you manage your assets so that you will meet the Medicaid eligibility requirements.
What Does Medicaid Consider as Assets?
- In general, Medicaid does not ask for an itemization of all personal property, like appliances, clothing, etc., but, at the same, you can’t own several diamond rings and an expensive art collection (for example) either. If you do, Medicaid will say you are well off and not in need of assistance.
- Home improvements that were done to make the senior’s life easier and more comfortable are exempt, but, again, at the same time, you should not install a jacuzzi or a swimming pool.
- Life insurance. The cash value of the senior’s life insurance policy should not exceed $2,500. The death benefit is not included in the Medicaid calculations.
- 401K plans are usually exempt from Medicaid calculations. However, the amount of payout can be considered as countable income.
- Any assets that can be converted to income are included in the Medicaid calculations.
- All joint bank and brokerage accounts with a spouse are considered 100% owned by the senior applying for Medicaid. Medicaid does not split these accounts 50/50.
- If you have a second home that you rent out, the income will be counted under Medicaid calculations.
- Revocable Living Trust assets are always counted as assets when applying for Medicaid benefits.
- The home may be exempt if within equity limits of $595,000 and if the applicant intends to return home in the future. However, if there is a spouse or minor child who resides in the home, it is exempt regardless of the home’s value. Florida is unique in its Homestead law that helps protect family homes.
- If a child has been a resident of the home for two years prior or co-owns the home prior to the senior applying for Medicaid, then the senior can transfer the home to the child without penalty.
- Vehicle: Regardless of the value, one car is exempt. But it should not be a luxury vehicle, like a Mercedes, BMW, or another expensive car. If you have a second car that is older than seven years, it is also exempt.
- As long as the other spouse is not seeking Medicaid benefits, joint real-estate assets are exempt.
- Assets that you can’t sell. For example, it is well known that timeshares are quite difficult to sell but they are still considered an asset. To be exempt from Medicaid, you will need to show the government that you did try to sell the timeshare but were unsuccessful.
- Prepaid funerals for you and all members of your family are exempt from Medicaid calculations.
Once you know which assets are exempt from Medicaid calculations, your Medicaid lawyer can develop strategies regarding how to legally convert the other countable assets into non-countable assets so that you meet the Medicaid eligibility criteria.
What are the Asset Limits for Florida Medicaid Long-Term Care?
It is important to note that Medicaid operates several programs and the asset limits do vary. However, if you are applying for nursing home care assistance, the asset limits are as follows:
- Single-person application: If a single senior is applying for long-term nursing care, then the asset limit is $2,000.
- Married couple application: If a married couple decides to apply for Medicaid long-term care benefits, then the asset limit is $3,000.
- Asset limits for a married couple but only one needs Florida Medicaid benefits. Sometimes only one spouse may need long-term nursing care assistance or may decide to stay at home and require extra assistance with daily living activities. In these situations, the “well” spouse will be permitted to keep the community spouse resource allowance (CSRA), which is about $130,000, while the spouse requiring Medicaid can keep no more than $2,000. The combined assets between the couple will be $132,000 plus other exempt assets.
The Income Limit for Medicaid Benefits
Besides the asset limit, all Medicaid applicants have to meet the income limit requirement for long-term care. Whether single or married, the applicant cannot earn more than the income cap amount, which is $2,382 per month. Again, as with the asset limit, Medicaid will ask to see statements of all incomes; if it is greater than $2,382 a month, then your application will not be approved.
Your lawyer may then suggest a “Miller Trust” (also known as a Qualified Income Trust, or QIT) achieve the required income limit. For example, even though you may have a high income, you may still qualify if you can show that your medical bills are enormous, and you have medical debt.
The Medicaid rules for long-term care benefits are not always clear and each applicant can be assessed differently. If you are planning for long-term care in the near future and may require financial assistance, consult with a lawyer who is knowledgeable in elder care and Medicaid requirements. If your income or assets are above the limits set by Medicaid, the Florida Medicaid attorney can suggest legal ways to diversify your assets and help you become eligible for Medicaid benefits.