It should be noted that the laws around this change often. This has been updated as of February 25th, 2020.
Medicaid Long-Term Care in Florida
Medicaid has numerous programs that are offered throughout the country. Generally, for those over the age of 65 or disabled, it is a needs-based form of governmental insurance for medical bills. Medicaid can be used both to cover the costs of general healthcare as well as long-term care.
The form of Medicaid that most frequently affects the elderly is referred to as the Medicaid Institutional Care Program, which is both a state and federal program that pays for nursing home or assisted living costs for applicants who qualify.
In Florida, eligibility is determined by the Department of Children and Families (DCF). It is important to note that if you have been deemed eligible in another state but have recently moved to Florida you will need to reapply for Medicaid benefits in Florida to DCF.
Why is Medicaid Long-Term Care Important?
In 2020, the average cost for a private room in a nursing home was $9,064 per month. Further, the average cost of assisted living in Florida was $3,045 per month and the average cost of in-home care in Florida is $19.95 per hour. These figures are further increased if the patient has Alzheimer’s or other form of dementia due to the higher level of supervision and security that is required to ensure their ongoing safety.
Very few seniors, or their families in support, have the financial means to afford these additional living expenses that arise later in life. However, these costs do not have to come entirely out-of-pocket with proper Medicaid planning.
Current Medicaid Eligibility Requirements:
- Applicants must be a resident of Florida as well as a U.S. citizen or have proper immigration status.
- Applicants must be either 65 years old or have a disability as designated by the Social Security Administration.
- Applicants must be in need of nursing facility level of care.*
- Applicants must meet the financial requirements set by Florida, with some applicable exemptions.**
*Nursing facility level of care does not necessarily mean that the applicant must require around-the-clock care, but rather, Florida uses a standard in-person diagnosis to evaluate the degree to which an applicant needs assistance in their daily lives. For applicants that suffer from dementia or memory loss, the state also recognizes the need for supervision even without any physical impairments.
**Financial requirements imposed by the state cover both monthly income as well as asset limitations as detailed below:
Monthly Income Limitations:
- In 2020, the income limit for an applicant is $2,349 per month as an individual and $4,698 per month for couples.
- Limits include all sources of income such as wages, Social Security benefits, retirement accounts, annuities, veteran’s benefits, SSI benefits, and pensions.
Individuals or couples with income in excess of the limits may still be able to qualify for Medicaid benefits through the use of a Qualifying Income Trust commonly referred to as a “Miller Trust.”
- Assets are divided into two categories: exempt and available. Exempt assets do not have any negative affect in regards to Medicaid eligibility.
- Exempt assets include:
- Up to $2,000 in cash or non-exempt assets for a single applicant and up to $3,000 in cash or non-exempt assets as a couple. The community spouse or the spouse that remains in the home is allowed to have $128,640 in countable assets in 2020.
- Homestead property with an equity limit of $595,000 for an individual, unlimited for a married couple. It is important to note that issues can arise with Medicaid eligibility if you plan on selling your residence so make sure speak with a legal professional before executing the sale!
- One automobile.
- A second automobile, so long as it is older than seven years old but not considered a “classic” or “collector’s car.”
- Prepaid burial plot(s).
- Cash value of $2,500 for life insurance per individual and $5,000 per couple.
- Personal property such as furniture, clothing, jewelry, and other personal effects.
- A burial account with no more than $2,500.
- If an applicant owns assets that are not exempt, these assets will need to be liquidated and applied towards the cost of the nursing home before the applicant can receive the benefits.
- Please be advised that Florida has a look back period of five years that includes penalties for applicants who attempt to sell assets below fair market value, transfer assets to friends or family members, or simply give assets or money away in order to meet the financial qualifications for Medicaid Long-Term Care.
How Improper Medicaid Planning Affects My Legacy
Even after death, Federal law mandates that states, including Florida, seek recovery from the estate of a Medicaid Long-Term Care recipient. In Florida, this is referred to as the Medicaid Estate Planning Recovery Act. Essentially, being a beneficiary of Medicaid creates a debt that has to be paid upon the death of the Medicaid recipient from the probatable estate. If there is insufficient cash assets to satisfy the claim, Medicaid is permitted to force the sale non-exempt real and personal property.
Fortunately, there are a number of limitations placed on Medicaid Estate Recovery by the State of Florida in what it is able to recover:
- Attempts at collection cannot commence until after the recipient has passed away;
- The recipient must be at least 55 years old in order to create a debt;
- Medicaid can only collect from the probatable estate (meaning proper Medicaid and estate planning could shelter the agency’s ability to collect the debt which is extremely important);
- The debt is not enforceable against the decedent if they were survived by a spouse, a child under the age of 21, or a child who is blind or permanently disabled;
- The debt is not enforceable against property that is exempt from creditors, namely homestead property; and
- The agency cannot collect the debt if collection would cause undue hardship for the heirs of the deceased, which allows a personal representative of the estate to request a waiver of the debt; Consulting with an Elder Law attorney early is essential to securing government assistance and leaving behind a legacy that you worked your entire life to achieve, contact the Finity Law Firm to book your free consultation today.