Getting Medicaid At Home
Most of the discussion here have been about Medicaid in the assisted living facility but the State of Florida will provide help at home for an applicant. The main point of HCBS Medicaid is to keep people out of the nursing home, so benefits are provided at home. We often see, however, that unless there is a full time in-home caretaker, the benefits are not enough to stay at home, even with Medicaid providing some assistance. Benefits will generally provide about 3 hours of home healthcare workers per day for about 18 hours/week, on average. We generally think about home Medicaid as help/respite for the in-home caregiver.
Does Medicare Pay For Any Home Care
It is very rare for Medicare to pay for any home-based services, particularly personal or custodial care. The general exception to this rule is if such care falls under the description of doctor-prescribed medically necessary treatment for illness, injury, or condition, including:
- Physical therapy, occupational therapy, and speech-language pathology
- Skilled nursing care needed on a part-time or intermittent basis
- Medical social services
- 80% of the cost for durable medical equipment such as wheelchairs, hospital beds, oxygen, and walkers, and 100% of other medical supplies)
As long as these services remain medically indicated and your doctor reorders them every 60 days, Medicare will cover such service indefinitely with no additional requirement of improvement or expected improvement.
Medicare will also pay for ongoing long-term care services in or outside the home for patients with ALS, Alzheimers disease, Multiple Sclerosis, Parkinsons disease, or stroke.
Finally, Medicare covers hospice care if :
- You have a terminal illness
- You have elected to no longer seek a cure
- Your life expectancy is six months or less
Hospice care may be received in your home, in a nursing home, or a hospice care facility. Short-term hospital stays and inpatient care may also be approved for Medicare payment .
Best For Short Waiting Period: Lincoln Financial Group
Lincoln Financial Group
Why We Chose It: We chose Lincoln Financial Group as best for a short waiting period because it offers the best no-waiting-period policies, so you can enjoy immediate access to your benefit payout . For all covered services, including nursing homes and assisted living facilities, payments start immediately.
No waiting period for covered services
In business since 1905
A+ AM Best rating
Return of premiums if you dont need care
No medical exams or lab tests required
No online quotes available you must speak with an agent
Long-term care is a rider, must purchase a life insurance plan
Almost all long-term care insurers subject you to a waiting period, the time between the date when you first need a service covered under the policy, and the date your benefits start paying for the extra care you need. The Lincoln Financial Group, which has an A+ rating from AM Best, has the best policies that we found for short waiting periods. Its death benefit ranges from $50,000 to $500,000.
Its MoneyGuard II and MoneyGuard III policies both have zero-day elimination periods for coverage if you need a nursing home or an assisted living facility. A 90-day waiting period is typical among insurers.
Key features of MoneyGuard II include locked-in premiums, tax-free reimbursements for qualifying long-term care expenses, and no deductible.
Also Check: Dentist Who Accept Medicare And Medicaid
Medicaid For Floridians Needing Home Health Care
Home health care can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning.
LTCMC plans offer home health services as part of their benefit package, so if you are a participant in a LTCMC plan, you can receive assistance from skilled nurses, home health aides, or personal care attendants in your home, as long as your doctor or care coordinator has authorized those services for you and they are medically necessary for treatment of a specific impairment.
Best Choice Of Carriers: Goldencare
Why We Chose It: Golden Care, also known as National Independent Brokers, Inc., is a long-term care insurance brokerage that specializes in helping you create a tailored long-term care policy that works for you. The company works with top-rated long-term care insurers , earning the best choice of carriers category.
Lets you shop around not affiliated with any single carrier
Helps match you with carriers that fit your needs / budget
Offers hybrid Long-term care / life insurance policies
A+ rating from Better Business Bureau
Relative newcomer, in business since 1976
Not ranked by AM Best
No online quotes, must speak with an agent
Golden Care specializes in insurance products, including life and long-term care hybrid policies, life insurance, and annuities. Since 1976, GoldenCare has helped customers secure reliable policies from leading carriers. The company is accredited by the Better Business Bureau, which gives it an A+ rating.
Among the top-rated insurers in GoldenCare’s network are Mutual of Omaha, John Hancock, BlueCross BlueShield, Aetna, Allianz, Great American Insurance Group, Humana, Minnesota Life, Kemper, and Legal Shield, among others.
Because the Golden Care agents represent several insurers and are licensed in your state, you get the benefit of one-stop shopping and can compare different policies and different companies in one phone call. There is no charge to you.
The Crossover Between Medicare And Medicaid Regarding Nursing Facilities
If your stay in an SNF exceeds 100 days, or your ability to pay co-pays ends before the 100th day is reached, you may no longer be eligible to stay in the Medicare-certified SNF under Medicare coverage.
However, in many cases, Medicare-certified SNFs accept long-term care insurance an /or private payment. Many of these Medicare-certified SNFs are also certified as Medicaid Nursing Facilities .
If your private insurance or funding becomes exhausted, you can be switched to Medicaid NF coverage and continue to receive services in your current facility.
How To Find Medicaid Assisted Living In Florida
How To Find Medicaid Assisted Living in Florida
Id like to share with you one of my absolute favorite resources when it comes to researching assisted living in Florida. Its a breath of fresh air in that it is ad-free, and supported by the State of Florida .
Youll be glad you visited this site trust me!
Also Check: What Does It Take To Get Medicaid
Estate Recovery For Medicaid Users
If you received Medicaid coverage for long-term care services, the state can choose to recoup Medicaid costs. Federal law provides states with the ability to recover any or all costs incurred by Medicaid for long-term care services, including nursing home, home, or community-based services.
Estate recovery is typically initiated following the death of a Medicaid recipient who
- received Medicaid services either as a result of being permanently institutionalized, or
- was 55 years of age or older when the services were received.
If your spouse survives you, your estate is exempt from recovery until after their death. Estate heirs can apply for a hardship recovery waiver.
How Long Does Medicare Pay For Long
Total Medicare payments for long-term care delivered in an SNF are limited.
- Medicare pays 100% of the cost through day 20 of your stay in an SNF
- You are responsible for any out of pocket co-pay . Medicare will cover the balance owed through day 100 of your stay in an SNF
- After day 100, Medicare does not cover any costs for stays in an SNF
The above applies to Original Medicare.
Medicare Advantage plans cover the same services in an SNF, but the way cost-sharing is determined can vary.
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Bypassing The Assisted Living Wait List
The best way to by-pass the wait list to get Medicaid benefits for the ALF is through the 60 day wait period when an elder is already in a nursing home. If the elder is already in the nursing home, we often take advantage of this opportunity to apply for and receive Medicaid, then transition the elder to assisted living with Medicaid’s financial assistance. Once the elder receives Medicaid and has been in the nursing home 60 days, the applicant will be able to leave the nursing home and go home or to assisted living with Medicaid’s financial support. We have some good information on questions to ask when your elder enters the nursing home. Veteran’s benefits may also assist the elder and the surviving spouse of a war time veteran. This process is tricky but if your elder is ever receiving rehabilitation in a skilled nursing facility, now may be the time to get Medicaid for him or her.
Recipients Should Consider The Following When Choosing A Long
- What services do I think I need? Assisted Living? Home Health?
- Which plan has the providers I currently use or think I will need?
- Are the providers I need a part of the plan?
Recommended Reading: Will Medicaid Pay For Assisted Living In Ohio
Medicaid Institutional Care Program
The ICP long-term care Medicaid program is for those who require skilled-nursing / rehab / nursing home level of care only.
There is no wait-list for this program and approval will be granted in the same month the ICP applicant is financially qualified, medically qualified, AND submits a Medicaid application.
Once approved, the Medicaid recipient will pay their âpatient responsibilityâ or âpatient share of costâ and Medicaid will pay the entire difference for a semi-private room in a nursing home . All nursing homes must accept Medicaid in Florida, so this program can assist with the very best nursing homes in Florida.
If the Medicaid recipient is married to a non-Medicaid recipient , the Community Spouse may be entitled to a portion of the Medicaid recipientâs income as part of Medicaidâs anti-spousal impoverishment policy.
Best For Customization/flexible Options: Transamerica
Why We Chose It: We chose Transamerica as best for the ability to customize your long-term care coverage because it offers the most options to tailor your policy to your exact needs and its reputation as a leader in the insurance industry.
Wide selection of included benefits
Coverage available from age 19 to age 79
Flexible home care options
Plans dont lapse due to age or health changes
No online quotes, must speak to an agent
90-day waiting period for coverage
Riders cost extra to purchase
With nearly 300,000 policies in force and an AM Best rating of A, Transamerica policies offer the best range of included policy features, plus offers a large selection of optional riders to tailor your plan.
All of its offerings include:
- The option to choose a monthly cash benefit, which pays 10 times the MDB, instead of all the other benefits
- A remain-at-home benefit covers the cost for home modifications, such as a wheelchair ramp, or caregiver training
- Waiving of monthly premium fees waived once benefits begin
- Possibility to consider new, alternative long-term care services
- Hospice care for up to 180 days
- Up to 30 days per year temporary stays in a long-term care facility, adult day care, or in-home care
In addition to the wide range of included benefits, you can also pick and choose from riders, which are extra benefits that will increase your monthly premium, but offer peace of mind that you are covering what means most to you.
Humana Premier Rx Plan
Like the Walmart Value Rx Plan, the Humana Premier Rx plan also uses Walmart as its preferred cost-sharing partner. This means that living close to a Walmart location is key to saving the most on your prescriptions.
While this plan has a higher premium than the Walmart Value Rx Plan , the Humana Premier Rx Plan includes additional benefits:
- $0 deductible on tier 1 and 2 medications
- $0 copay on 90-day supplies of tier 1 and 2 medications from Humanas mail-delivery pharmacy service
- preferred cost-sharing at Humana Pharmacy, Walmart, Walmart Neighborhood Markets, Sams Club, Publix, Kroger, Harris Teeter, HEB, and Costco pharmacies
- $445 annual deductible on tiers 3 through 5 medications nationwide and $305 in Puerto Rico
- more than 3,700 medications on the plans list of covered drugs
Medicaid For Floridians Needing Assisted Living Facilities
A Florida assisted living facility provides room, board, and personal care services, such as help with dressing, moving, bathing, taking medication, and general care of your physical and mental wellbeing. Another kind of ALF is an adult family care home . AFCHs have no more than five residents, and the operator of the home must live in the home.
ALFs and AFCHs can be covered by Florida’s LTCMC plans. Each LTCMC plan will contract with its own providers, so not every ALF or AFCH will be covered under every plan. It is important to choose the plan that covers the facility you are in or that you want to enter.
Florida also has a non-Medicaid program called Optional State Supplementation that helps low-income qualified individuals pay for room and board at ALFs and AFCHs. You must apply through Florida’s Department of Children and Families.
Also Check: Moving To Another State Medicaid
Health Plans And Program
In Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program. The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types:
Managed Medical Assistance : Provides Medicaid covered medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services.
Long-Term Care : Provides Medicaid LTC services like care in a nursing facility, assisted living, or at home. To get LTC you must be at least 18 years old and meet nursing home level of care .
Dental: Provides all Medicaid dental services for children and adults. All people on Medicaid must enroll in a dental plan.
Humana Addresses Georgia Medicaid Plans On New Top Docs Show
The latest edition of the Medical Association of Georgias Top Docs show addresses Humanas plans to expand its Medicaid business into Georgia, and it features Humana Medicaid Regional President Jocelyn Chisholm Carter, J.D.
Humanas Medicaid business and its new Humana Healthy Horizons brand Humanas plans to expand its Medicaid business into Georgia Humanas value-based model Humanas Bold Goal strategy How Humana has supported its communities during the pandemic
Carter is the Regional President for Humanas Florida Medicaid and Long-Term Care business. She is an attorney who has more than 25 years of experience in the health care sector. Before she joined Humana, Carter held several key leadership positions with UnitedHealthcare including being the CEO for Uniteds Mississippi and New Jersey Medicaid plans. She has a law degree from the University of Baltimore School of Law. A native of Georgia, Carter received her bachelors degree from Georgia Southern University.
Between downloads and live listeners, Top Docs has now reached more than 1.8 million listeners and viewers which includes people in all 50 states and more than 80 countries. MAG has won four awards for the show, including an American Association of Medical Society Executives Profiles of Excellence Award, an American Society of Association Executives Silver Award, and two Health Information Resource Center Digital Health Awards.
What Other Options Exist To Pay For Senior Care
Most long-term senior care is not medical in nature, falling into the personal care category. Personal care is not covered by Medicare or Medicaid unless its provided in a skilled care setting under a skilled care plan in a skilled care facility. Even then, there are limits. This means that many times, the costs of senior care will need to be paid for using alternative means which may include:
- Personal savings and retirement accounts
- Long-term care insurance policies purchased prior to the need for them
- Reverse mortgages allow homeowners to draw on the equity of their home
- Some life insurance policies allow a certain percentage of the policys face value to be used to pay for costs such as these under certain conditions
- Accelerated death benefits may be allowed under certain conditions by life insurance policies
- Long-term care annuity contracts
- A life settlement
Some of these options have conditions and restrictions that must be met, while others require prior planning and purchase prior to needing them.
Who Does Not Have To Join A Plan
The following people are not required to join a Managed Long Term Care Plan. They may join a Plan if they want:
- Native Americans
- Adults age 18 20 who need more than 120 days of communitybased long term care
- Adults who are nursing home eligible and enrolled in the Medicaid Program for the working disabled.
People receiving the following services cannot join a Managed Long Term Care Plan. In some cases, you may leave your program to join a Plan.
Contact New York Medicaid Choiceif you are receiving any of the above services and you have questions. Counselors will be glad to assist you.Call: 18884016582TTY: 18883291541
New York Medicaid ChoiceTTY: 18883291541
Read Also: Do I Make Too Much For Medicaid
How Much Does Long
Monthly premiums can run from less than $25 per month for someone under 60 and in good health to over $500. Average premiums for long-term care policies are about $2,700 a year, about $225 each month. Premiums will vary based on your age, where you live, what features you want, and how much total coverage you will need.