Florida Medicaid Nursing Home Eligibility


Is Medicaid Readily Available

Medcaid and Nursing Homes in Florida

Nursing Home Medicaid is readily available in Florida for those individuals who meet the asset, income and ADL criteria. However, the federal government does not require the state to provide Medicaid funding for those who need care at home or reside in a community setting such as an assisted living facility . In February 2013, the state set a 5 year cap of 37,000 individuals who may receive Medicaid for home care and ALFs. As of January 2019, the waiting list had more than 52,000 individual applicants. According to a national study conducted by the AARP, the Commonwealth Fund and the SCAN Foundation, released on June 19, 2014, Florida ranks as one of the nation’s worst states in helping to keep seniors living independently and out of nursing homes. It ranked Florida at No. 43 overall on five measurements, including nursing home affordability, quality of care, and support for family caregivers. One of the key factors for the low ranking was the failure to provide adequate funding for home based care.

How To Apply For Long

For those applicants who are already at or below the income and asset levels, it is very typical that the nursing home does the application for you/the resident. Typically, the business office and/or social worker can do this when the resident’s income and assets are already below the applicable limit. If you/the elder is at home and looking to apply for Medicaid, then you would call your local Aging Resource Center to get placed on the long-term care wait list. There is no waitlist for nursing home Medicaid but there is a very long waitlist for assisted living and in-home Medicaid assistance.

If the elder’s assets are above the minimum level, then it is highly likely that the family will want to consult a good elder law attorney to learn legal ways to protect assets. Here, the elder law attorney would do the application for the elder after assets are legally protected, when appropriate.

Will Medicaid Cover The Cost Of Nursing Home Care In Florida

For better and for worse, Medicaid is the primary method of paying for nursing home care in the United States. But navigating the Medicaid system is complicated and confusing. Here are the basics.

Medicaid is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers long-term care for those who qualify. This coverage has traditionally meant care in a nursing home, although coverage of care in an assisted living facility or at home are possible .

In the absence of any other public program covering long-term care , Medicaid has become the default nursing home insurance of the middle class. Lacking access to alternatives such as paying privately or being covered by a long-term care insurance policy, most people pay out of their own pockets for long-term care until they become eligible for Medicaid.

Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive federal money, which pays for about half the states Medicaid costs. This complicates matters, since the Medicaid eligibility rules are somewhat different from state to state and they keep changing. To be certain of your rights, consult an elder law attorney in your state who can guide you through the complicated rules of the different programs and help you plan ahead.

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Emergency Medical Assistance For Non

Non-citizens may be eligible for Medicaid coverage in emergency situations including childbirth as long as they meet the other eligibility requirements.

To receive Medicaid coverage a non-citizen must do the following:

Complete a Medicaid application and provide the necessary verifications and

  • Provide proof from a medical professional that the treatment was for an emergency, meaning it was due to a medical condition of sufficient severity that could result in placing the persons health in serious jeopardy.
  • Medicaid can only be approved for the date of the emergency, and in case of childbirth there is no postpartum coverage.
  • Non-citizens in the United States for a temporary reason, such as tourists or those traveling for business or pleasure, are not eligible for any Medicaid benefits with the exception of lawfully residing children , who are potentially Medicaid eligible.

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Medical And Functional Criteria For Medicaid Long

Read Florida Medicaid eligibility requirements for long term care for ...

To receive institutional long-term care services paid for by Medicaid, an applicant must need a nursing home level of care. A medical specialist in the state conducts a needs assessment of the applicant and determines if they require care in a nursing home, care in an assisted living facility or if they are a candidate for home- and community-based services like in-home care services and adult day care. HCBS are a slightly different type of Medicaid program aimed at delaying or preventing applicants placement in institutional facilities like nursing homes. These services are typically provided through Medicaid waivers, which allow applicants to receive appropriate services in their own homes and communities.

Each state defines its own nursing facility level of care criteria, and the explanations are often very complex or vague. However, the requirements for meeting a nursing home level of care typically include a combination of medical, functional and cognitive components.

Medically, an applicant may need to be certified as requiring skilled nursing care from a licensed nurse . An applicants functional level is commonly determined by assessing their ability to perform activities of daily living . An evaluation is completed to identify how much assistance is needed with the following daily activities: eating, bathing, dressing, continence, toileting and transferring/mobility.

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Can I Qualify For Medicaid After Im In A Nursing Home

Even if you are already living in a nursing home, you can still qualify for Medicaid. While your benefits may be less than if you had engaged in Medicaid planning prior to moving into a nursing home, nonetheless it is still usually beneficial to take actions that may result in Medicaid assistance.

Over two-thirds of all Florida nursing home residents pay for their care through Medicaid. If a Floridian is already in a nursing home, the nursing home has a designated Medicaid bed available, and the individual meets the financial and health eligibility requirements, the applicant can receive Medicaid to help cover care expenses.

Eligibility For Medicaid Services

Recipient eligibility for Medicaid is determined by the:

Each program has its own income and asset requirements.

Information about Medicaid eligibility criteria for the aged, blind and disabled, and children and family programs can be obtained from the Department of Children and Families Web site or the DCF region / circuit office closest to you.

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Florida Medicaid Income Limit Charts

The FL Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Florida who qualify for Medicaid.

Florida Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

Florida Medicaid Income Limit Children
Children Medicaid Ages 0-1

How to Read the Florida Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 191% of the Federal Poverty Level which for a family of two is $33,272 as shown in the chart above.

Florida Medicaid Phone Number

Nursing home against proposed Medicaid changes

Heres how to contact Florida Medicaid:

To reach Florida KidCare, call 1-800-821-5437.

For Medicaid Applicant & Member Services, call 1-877-711-3662, TDD 1-866-467-4970.

Customer Service is available Monday through Thursday from 8 a.m. to 8 p.m. Friday from 8 a.m. to 7 p.m.

If you are not enrolled in a health plan, call the Medicaid Helpline at 1-877-254-1055.

Also, if you need help finding contact information for your Medicaid plan, call ourMedicaid Helpline at 1-877-254-1055. You can get help with:

  • Locating a doctor
  • The services your plan covers
  • Transportation to access covered services
  • Other general questions you may have

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Eligibility Requirements For Long

The most basic and universal requirements a person must meet to qualify for Medicaid include being a U.S. citizen and meeting residency rules in the state where the applicant intends to apply.

Additionally, an applicant must:

  • Be age 65 or older OR
  • Have a permanent disability as defined by the Social Security Administration OR
  • Be blind.

Most states automatically provide Medicaid eligibility to applicants who apply and are deemed eligible for Supplemental Security Income . However, there are a handful of states who use the same eligibility guidelines but require an applicant to file separate SSI and Medicaid applications to receive both benefits. You can learn more about SSI benefits at SSA.gov.

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How Much Do Nursing Homes Cost In Florida

In Florida, the cost for long-term care can be significant. In 2019, for instance, the monthly median costs in Florida for certain healthcare services was:

  • Assisted Living:
  • Semi-Private Room $8,547
  • Private Room $9,387
  • For low-income Florida seniors without health insurance or whose insurance does not cover their needs, Medicaid provides financial assistance for healthcare and related expenses. However, it is not just those in low-income who will be greatly affected by the high costs for nursing home care such costs can also quickly wipe out the life savings of middle-class households.

    Seeking Medicaid benefits can often make the difference in a couple being able to retain their house and some assets vs. going broke paying for nursing home costs.

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    How To Apply / Getting Started

    Every State has an agency that is in charge of administering the Medicaid Applications within that state. The Florida Department of Children and Families is the agency that administers the application process in Florida.

    Eligibility for Medicaid for long-term care services, Nursing Home Medicaid, and Medicaid programs that provide for Assisted Living Facility or at home assistance all have the same financial requirements that must be met. Both husband and wife will need to provide documentation regarding assets and income as part of the application process. I know this seems like a violation of our right to privacy, but the Congress and Senate have not yet made it a right for everyone to receive Medicaid Long Term Care. Medicaid qualification for Long Term Care is optional and available for those who choose to apply and are willing to provide the necessary documentation to prove they meet the requirements. The basic financial requirements are that an individual receives less than $2,313/month income and has less than $2,000 in assets. For a couple, the community spouse may retain $126,420 for what is called a resource allowance, and the community spouse income is unlimited. That is the basic Financial Standards for Medicaid Institutional Care Program , which covers Long Term Care. These standards DO NOT APPLY to any other Medicaid program.

    Florida Nursing Home Medicaid Eligibility Requirements

    Florida Medicaid Eligibility: 2018 Income &  Assets Limits

    There are several general requirements for determining an applicants Nursing Home eligibility. To be eligible for Florida Medicaid ICP Benefits, the applicant must meet all of the following general requirements:

    • 65 years of age, blind or disabled.
    • U.S. citizen or qualified alien, Getting a Green Card in Florida. When you are not a lawful permanent resident or U.S. citizen, obtaining a green card is initially the holy grail of the immigration process. A green card provides authorization to live and work throughout the U.S. as well as the right of re-entry if you need to leave the country.
    • Florida Resident.
    • An asset limit of $2,000, or $5,000 . The community spouse may keep up to $126,420 of assets.
    • Monthly gross income must not exceed the Florida State Income Standard . However, only the income of the individual residing in a nursing home is counted. If the individuals monthly gross income exceeds this limit, it is possible to establish an Income Trust to become eligible.

    The Requirements must also be met for long term care institutional Medicaid as determined by the Florida Department of Elder Affairs CARES field office, and be placed in a Medicaid certified facility to provide the level of care as needed.

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    Medicaid Eligibility For Persons With Disabilities

    Individuals that are unable to work due to a disability may receive cash assistance through the Supplemental Security Income program. Qualifying for SSI automatically qualifies you for Medicaid in most states, but not all. The federal government requires all states to offer Medicaid to low-income disabled individuals. However, states are still allowed to set their own income eligibility requirements. Ten states, referred to as the 209 states have set income requirements that are more restrictive than SSI requirements. This means that individuals receiving SSI are not guaranteed Medicaid. They have to apply separately and be approved. These ten states are Connecticut, Hawaii, Illinois, Minnesota, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, and Virginia.

    For individuals with a disability that have not been qualified for SSI, there are still options to qualify for Medicaid. Most states allow individuals with an impairment to prove that their impairment has prevented them from being able to work for at least one year. Once this is proven, the individual will be able to apply under the income and asset requirements for people with disabilities.

    Medicaid Basics In Florida Once Medicare Skilled Rehabilitation Terminates

    Typically, a person who is over age 65 and receiving Medicare health insurance who has been admitted to the hospital for treatment of an illness, once stabilized, will oftentimes not be quite strong enough to go home and will instead be transitioned from Medicare Part A hospitalization to Medicare Part A skilled rehabilitation status.

    In order to qualify for Medicare Part A skilled rehabilitation services a person must be admitted to the hospital for treatment of a medical condition for 3 nights with discharge occurring on the 4th day. Be sure the hospital has not coded the person as admitted for observation purposes. Observation will not allow the person to qualify for rehabilitation benefits under Medicare Part A.

    It is rare a hospital keeps a person for skilled rehabilitation. Those services are typically provided in a skilled nursing home setting. Nursing homes have dedicated beds for Medicare Part A skilled rehabilitation services.

    The nursing home also have long-term beds. Long-term beds are for those who no longer qualified for rehabilitation services under Medicare Part A, but require on-going skilled nursing care due to a medical condition. Medicare does not cover the cost of a long-term care bed. This is where Florida Medicaid has programs designed to subsidize paying for a persons long-term care bed.


    Institutional Care Program Nursing Home Medicaid

    Effective January 1, 2021

  • Hospice
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    We Invite You To Call Us To Learn How Effective Medicaid Planning May Be Beneficial To You

    As we are a Florida elder law firm, this article is focused solely on the needs of seniors seeking Medicaid benefits. It is also important to note that the information contained herein are subject to change. As a result, this information should be considered as general information only, and nothing contained in our website should be relied upon as legal advice. Because the circumstances of every individual will differ, if you desire legal advice for your situation, please call our firm to schedule an appointment.

    Access Florida, Florida Department of Children and Families, https://www.myflfamilies.com/service-programs/access/medicaid.shtml

    How Much Care Will You Need?, LONGTERMCARE.GOV, https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html

    Eligibility, Medicaid.gov, https://www.medicaid.gov/medicaid/eligibility/index.html.

    How Many People Are On Medicaid

    Florida Medicaid HCBS | Navigating the Program

    According to the Centers for Medicare & Medicaid Services, as of July 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:

    • 75,521,263 individuals were enrolled in Medicaid and CHIP
    • 68,826,573 individuals were enrolled in Medicaid
    • 6,694,690 individuals were enrolled in CHIP

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    New Requirement For Medicaid Effective November 2017

    If you are turning age 65 within the next three months or you are age 65 or older, you may be entitled to additional medical benefits through the Medicare program. You may be required to apply for Medicare as a condition of eligibility for Medicaid.

    Medicare is a federal health insurance program for people age 65 and for certain people with disabilities, regardless of income. When a person has both Medicare and Medicaid, Medicare pays first and Medicaid pays second.

    You are required to apply for Medicare if:

    • You have Chronic Renal Failure or Amyotrophic Lateral Sclerosis OR
    • You are turning age 65 in the next three months or are already age 65 or older AND your income is below 120% of the Federal Poverty Level , or is at or below the applicable Medicaid Standard, then the Medicaid program will pay or reimburse you the cost of your Medicare premiums. If the Medicaid program can pay your premiums, you will be required to apply for Medicare as a condition of Medicaid eligibility.

    If you have Medicaid and appear to be eligible for Medicare based on any of the criteria above, you must apply and show proof of Medicare application, or risk losing your Medicaid coverage.

    When you apply for MEDICARE:

    If you go to your local SSA office, you should bring:

    • Proof of date of birth and
    • Proof of U.S. citizenship or lawful residence and
    • A copy of your Social Security card and your Medicaid card.

    Proof of Medicare application can be:

    • Social Security Administration 1-800-772-1213


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