How to Qualify for Long-Term Care Medicaid Programs in Florida

The cost of care for a nursing home in Florida is over $100,000 per year. By 2030 one in four Floridians will be over the age of 65, and many will need long-term care benefits. How will you pay for care as you age? Can you afford the cost of assisted living or nursing home care? Medicaid is often the answer. Medicaid pays for roughly 60 percent of long-term care spending, yet applying for Medicaid is difficult and confusing! Friedman Elder Law Department is here to help.

Will Medicaid Pay For Long-Term Care Services?

There are two Medicaid programs for Florida seniors who need ongoing medical care. Each Medicaid program offers a different level of benefits or coverage of care, depending on your specific needs.

The Home and Community Based Services Long Term Care Waiver program (HCBS) is for seniors who live at home or in an assisted living facility. If eligible, Medicaid pays for extra help to keep you out of a nursing home. Medicaid will pay for over two dozen home and community-based services including services like personal care, respite care, transportation, in-home health care, therapy, and more.

The second program is the Institutional Care Program (ICP) or nursing home Medicaid. This program is specifically for those who need nursing home care, often called skilled nursing care. Medicaid will pay the cost of care for someone who needs a nursing home but can’t afford the high cost.

How to Qualify for Long-Term Care Medicaid in Florida

To qualify for the Medicaid HCBS Long Term Care Waiver program, you must need nursing home level of care, but with help, would still be able to live at home or in assisted living. Two state agencies decide if a person is eligible for the HCBS Waiver. The Department of Elder Affairs decides medical eligibility, and the Department of Children and Families (DCF) decides financial eligibility for Medicaid.

To qualify for the Institutional Care Program, or nursing home Medicaid, you need to meet a care need level defined as skilled or intermediate by the DCF and be living in or moving to a nursing home that accepts Medicaid. To apply for either program you must meet the Medicaid residency and financial eligibility rules.

Medicaid eligibility requirements include:

  • Be over 65 or disabled
  • Be a US citizen and Florida resident
  • Have a social security number
  • Have applied for other qualifying benefits
  • Meet Income and Asset limits (financial eligibility)

Navigating the income and asset rules is often the hardest part of a Medicaid application. As of July 2022, to be eligible, a person applying for benefits can not have more than $2,000 in assets. For married couples, the spouse in the community may keep up to $137,400 without penalty. These numbers change on July 1st annually, and current values can always be found on the DCF website.

For eligibility, Medicaid looks for “countable” assets. This includes cash, real property, savings accounts, stocks, and more. There are very few assets that Medicaid will not count. These “excluded assets” include your home, one vehicle, an irrevocable funeral contract, some types of life insurance, and assets protected under a qualifying long-term care insurance partnership policy.

Further, to be eligible for Medicaid your income must be below a certain amount. The income limit for Medicaid applicants is 3x the SSI amount, and again, changes annually. Medicaid uses your gross income from all sources including social security, veterans administration benefits, and pensions. Generally, you must accept and count all sources of income available to you.

Even if you believe your income or assets are too high, you may still be eligible. Our lawyers can navigate Medicaid’s rules and utilize all available tools and planning techniques. Assets can often be converted from countable to excluded by making certain purchases or allowable transfers. There are also legal techniques available to decrease your countable income. One option is using a Qualified Income Trust where extra income is moved to the trust each month. This type of trust must meet strict Medicaid requirements to qualify and should only be drafted by an experienced lawyer.

In addition, Medicaid also wants to know about your income and assets prior to your application. One often confusing rule is Medicaid’s rule against giving away assets. This is called a five year look back period.

What is the five year Medicaid look back period?

When you apply for Medicaid, DCF will review your finances for the five years prior to your application. DCF is looking to see if you have transferred or gifted away anything for less than fair market value that could have been used to pay for care services or done on purpose to qualify for Medicaid. Any transfers or gifts, even unintentional, that don’t meet Medicaid’s strict criteria will cause your application to be denied.

However, there are very limited circumstances when transfers are allowed. For example, with married couples, transfers between spouses are acceptable. With proper pre-planning, you may be able to transfer assets in advance, like into an Irrevocable Trust, to be held beyond the five year look back period. Consulting with a qualified elder law firm like the Friedman Elder Law Department is key to taking advantage of these planning techniques.

How do I apply for Medicaid Benefits in Florida?

You can apply for the ICP or the HCBS Waiver online with DCF or with a DCF community partner. However, neither can give you legal advice.

The Medicaid application is time consuming, difficult and confusing. Applying on your own can lead to thousands of dollars in missed benefits, penalties, and denials. Let our experienced elder law lawyers guide you through the process.

Get Help Applying for Long-Term Care Medicaid

Don’t risk your benefits by applying without help. Friedman Elder Law Department is experienced at navigating Florida’s complex Medicaid rules. Our office will work with you before, during and after the application process. Our experienced lawyers will help you avoid common mistakes and get your Medicaid application approved without the stress. Contact us today.

If you are in need of long term care or you or a loved one is already in a nursing home, call our office today. Care costs are high, but Medicaid’s benefits programs for seniors can help.

Friedman Elder Law Department will review your Medicaid eligibility and use all available tools to both preserve your assets, and get you approved. Let us provide you and your family with peace of mind. It’s never to early or late to plan for your long-term care. Give us a call at (954) 866-1055 or click here to get started.

It's time to protect yourself & those you love.

Whether you are preparing for future long-term care needs, are seeking Veteran’s Benefits, or have a loved one entering or already in a nursing home, we are ready to assist you.

Take your first step by contacting us today.

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