It’s an incredibly challenging time having to transition a spouse to a nursing home. Your loved one may not realize the level of care they need and may push back against this decision. It’s a big enough hurdle to introduce them to a new living situation while having to go through the cycle of explaining the need for this form of care. On top of everything is the process of proving eligibility for Medicaid. Despite the immediacy of a person’s need for Medicaid coverage, they need to fulfill several criteria before going through the application process.
Understand the requirement for eligibility
The state administers Medicaid where the applicant is a resident. The Florida Agency for Health Care Administration runs Florida’s Medicaid program. When a person qualifies for Institutional Care Program (ICP), the state of Florida may account for the difference between their income and the cost of a nursing home. You must attempt to anticipate any financial need that could lead to a Medicaid application.
Medical Necessity Test: You have to determine whether a person needs around-the-clock medical care or partial assistance. They would need to demonstrate an amount of care requiring a nursing home. A medical assessment will determine a person’s healthcare needs.
Asset Test: Different Florida Medicaid programs have varying asset limits. As a working example, a single person seeking a full-time assisted living facility may not have more than $2000 in countable assets.
Income Test: Florida residents need to have a low income and low financial condition to qualify for these benefits. Though the applicant’s monthly income is factored into the eligibility, a spouse’s income may be considered separate in the evaluation. For married applicants, the non-recipient of Medicaid benefits is called the community spouse. It is a common situation that one spouse may need care from an institution while the other remains healthy in comparison. There are laws designed to keep the community spouse from having their finances drained in some situations to maintain the cost of care.
Plan for the future
Protecting a loved one’s health and meeting their care needs is a careful balancing act considering the emotional strain involved. Medicaid requires a complicated application process that can be frustrating to navigate. As you continue your life, you need to maintain your good financial standing while ensuring a loved one is cared for. You should learn more about the Medicaid requirements before you begin this undertaking.
