Services Included In The Nf Benefit
A NF participating in Medicaid must provide, or arrange for, nursing or related services and specialized rehabilitative services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident.
There is no exhaustive list of services a NF must provide, in that unique resident needs may require particular care or services in order to reach the highest practicable level of well being. The services needed to attain this level of well-being are established in the individual’s plan of care.
Specific to each state, the general or usual responsibilities of the NF are shaped by the definition of NF service in the state’s Medicaid state plan, which may also specify certain types of limitations to each service. States may also devise levels of service or payment methodologies by acuity or specialization of the nursing facilities.
Nursing Home Level Of Care And Medical Necessity In Florida
To qualify for Florida’s LTCMC program, you must require a nursing home level of care. That means that you must be able to show that your condition is serious enough that you either need to be in a nursing home, with the availability of round-the-clock nursing care, or would need to be in a nursing home if you were not receiving supportive long-term care services.
Comprehensive Assessment and Review for Long-Term Care Services is Florida’s screening program for long-term care applicants. CARES assessments are done by the Department of Elder Affairs. Someone will personally interview you and ask you many questions about your ability to function, the help you need, and your medical conditions. You will need a CARES assessment to show that you meet the nursing home level of care necessary to qualify for Florida’s managed long-term care programs.
Once you show that you require a nursing home level of care and you enroll in an LTCMC plan, you will need to show that the service you want is medically necessary. LTCMC plans will only pay for services that are medically necessary. In Florida, medically necessary means that the service:
The CARES assessment, along with input from your treatment providers, will help your plan determine whether the particular long-term care service that you want is medically necessary for you.
Medicaid Benefits For Long Term Care Nursing Home Costs
What is the Medicaid look-back period and the penalty period?
In Florida, Medicaid eligibility for long-term nursing home care is based on the assets and income of the Medicaid applicant, as well as the assets and income of the Medicaid applicants spouse. If the Medicaid applicant or spouse has excess assets, many legal steps may be available to allow the applicant to become Medicaid-eligible without spending all funds on the nursing home!
CAUTION: Medicaid eligibility criteria for nursing home long-term care are complex and change frequently. An improperly filed application may result in denial of benefits. Consult with The Karp Law Firm. Our Florida elder law attorneys are knowledgeable in Medicaid law and the legal implications of transfers.
Heres a brief summary of Medicaid eligibility requirements for long-term nursing home care.
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Qualifying For Medicaid To Pay For Assisted Living
Long-term care Medicaid is a joint federal and state program that helps seniors with low income and limited assets get the care they need. Specific income and asset limits vary depending on factors like the kind of care required, a seniors medical diagnosis, where they live and their marital status. A doctor must also certify that a seniors need for care in an assisted living facility is medically necessary.
If a senior meets all financial and functional eligibility requirements, they must then find an assisted living facility that accepts Medicaid as payment. This final step can be difficult since there are typically few Medicaid-certified assisted living facilities due to low reimbursement rates. If a facility does accept this form of payment, they may only have a limited number of beds available for Medicaid patients. The best way to find a Medicaid facility is to contact the nearest Area Agency on Aging .
Keep in mind that assisted living can be referred to by many different names, including adult foster care, board and care homes, residential care, group homes, personal care homes and memory care facilities. Understanding how your state refers to this type of care will make it much easier to navigate eligibility requirements, file an application and find a care facility.
Area Agencies On Aging
The AAA is a network of regional offices commissioned by the Federal government to provide program development, information, and resources to seniors at the local level. In many states, the Area Agencies on Aging are also referred to as Aging and Disability Resource Centers, and in the state of Florida, these Agencies work closely with the Department of Elder Affairs. The goal of the Agencies is to facilitate access to care and to reduce confusion in the long-term care coverage arena.
For information relevant to the aging, local AAA offices may be a Florida citizens greatest available resource. Consult the directory below to find the AAA location serving your region.
|Area Agency on Aging|
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What Medicaid Covers In Assisted Living
The exact services that Medicaid covers will vary by state and the specific program a senior applies for. All states offer some degree of personal care services , but the ways in which they are administered differ widely. For example, some state Medicaid programs provide eligible seniors with personal care assistance but not in an assisted living residence.
Generally, though, the fundamental services that most Medicaid programs will pay for in an assisted living facility include:
- Personal care services
- Personal emergency response systems
Background Checks For Assisted Living
Extensive background checks are required of Florida ALF employees, administrators, owners, and board members. A fingerprint scan is used to search the databases of the FBI and the Florida Department of Law Enforcement. Due to the large size of the pool of long-term care workers in Florida, this state takes measures to carefully review background reports on an individualized basis, and to deliberate on the significance of any potentially disqualifying marks. A person cannot be professionally associated with an ALF if they have any past convictions or substantiated reports of violent behavior, abuse, neglect, or exploitation.
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What Is A Medicaid Lookback Period
The Medicaid lookback period is a period of time in which any transfers of assets to family members may be subject to scrutiny for Medicaid eligibility. If it’s determined that you specifically transferred assets during the lookback period in order to qualify for Medicaid, this can affect the benefits for which you’re eligible.
Assisted Living Medicaid Policy
Florida Medicaid doesnt directly finance assisted living. However, there are several programs that do reimburse for personal care services received in an assisted living facility. Nursing home-eligible residents may have their personal care services, such as assistance with activities of daily living, reimbursed under Floridas Long-Term Care Waiver program. Florida Medicaid also administers a large PACE program, and facilities licensed to accept Medicaid may accept especially frail seniors who are covered under PACE. Its important to note that Florida residents arent entitled to receive funding from these programs, and the number of participants is limited so not everyone who qualifies will be able to take advantage of the funding provided.
Room and board costs at Florida ALFs are not capped for Medicaid recipients as they are in some other states. Instead, costs for room and board, and also for services are negotiated by the managed care provider through which a resident receives their Medicaid waiver services. For recipients of SSI, an $80 optional state supplement is provided, and the amount they are expected to pay to their ALF is set at $775.
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The Department Of Elderly Affairs
The Department of Elderly Affairs is a department of Floridas state government, and works with the Area Agencies on Aging to administer most state programs concerning the elderly. This department offers a long list of social and financial services with the goal of helping seniors remain as active and independent as possible. Services they offer include caregiver respite, transportation, intergenerational social programs, adult protective services, and the administration of multiple helplines providing resources and information.
Visit the Department of Elder Affairs online to view a complete list of free support programs for seniors. The Department can be contacted by calling 963-5337, or by locating your local Area Agency on Aging in the directory below.
What Assets Are Included In Determining Medicaid Eligibility In Florida
There are asset eligibility caps to qualify for Medicaid:
Medicaid counts these assets for eligibility:
- Stocks and Bonds
- Checking and savings accounts
- Second homes/vacation homes not being rented out for fair market value
- Anything beyond one motor vehicle
- Cash value of life insurance if face value exceeds $2500
- Pre-paid funeral plans
These assets are not counted toward Medicaid:
- Your primary home and primary vehicle
- Qualified Retirement Accounts
- Income-producing properties
- Personal property and household belongings
- Life insurance policies with no cash value
- Up to $1,500 in cash earmarked for burial
- Assets with multiple owners
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Medicare Vs Medicaid Roles In Nursing Home Care
Medicare does cover nursing home careup to a point. If you are sent to a skilled nursing facility for care after a three-day inpatient hospital stay, Medicare will pay the full cost for the first 20 days. For the next 100 days, Medicare covers most of the charges, but patients must pay $185.50 per day unless they have a supplemental insurance policy. For day 101 and beyond, the patient pays all costs.
These rules apply to traditional Medicare. People on Medicare Advantage plans likely have different benefits
Some nursing homes wont accept Medicaid patients outright, but the law forbids them from throwing you out if you become dependent on Medicaid when you are in their care.
Does Medicaid Pay For Assisted Living
For many seniors, seeking assisted living is a conscientious decision. Many individuals are choosing to move into assisted living communities so they can easily maintain a healthy lifestyle, enjoy social opportunities, engage in meaningful activities, and not have to rely on family for support with health issues or with activities of daily living.
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Need Help With Your Elder
We charge $200 to consult with our elder law attorney where we will:
- Evaluate your elder’s situation
- Translate the issues you are having – there is a great deal of bad information you will receive in helping your elder – we cut through the BS!
- Review the estate plan/durable power of attorney
- Discuss how Medicaid may help your elder’s situation
- In the event you need further help, we will quote a fee for any services
We can help your elder no matter where you live! We have done thousands of Medicaid applications helping families in difficult situations and we are glad to help you.
Other Financial Assistance Options For Nursing Home Care In Florida
While Medicaid and Medicare are two of the most common programs used to pay for Nursing Home Care, there are other financial assistance options available, depending on your unique situation.
How to Apply
Aid and Attendance
Learn more and apply online at va.gov.
Veterans who receive a VA pension may also be eligible for the Aid and Attendance benefit, a monthly cash allowance that veterans receive in addition to their standard pension amount. The benefit is intended for veterans in need of long-term care services and may be used towards paying for skilled nursing care.
Learn more about your options and how to apply at ftc.gov
If you own a home, you may be able to use a reverse mortgage to help pay for nursing care. Reverse mortgages are loans that one can take out against the value of their home, essentially converting some of the home’s equity into cash. Reverse mortgage loans do need to be repaid with interest, typically within 12 months of receiving the loan.
< Long-Term Care Insurance
Learn more about Long-Term Care Insurance and how to apply for a policy at acl.gov.
Seniors who already have long-term care insurance may be able to use it to pay for skilled nursing care. Most policies cover at least a portion of the cost, but it depends on the specific policy terms. Note that older adults who are already in need of skilled nursing care will not typically be eligible to sign up for a LTC insurance policy.
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How Your Assets Impact Eligibility
Besides income, your assets will be counted toward meeting eligibility requirements. Countable assets include checking and savings account balances, CDs, stocks, and bonds.
In most states, you can retain up to $2,000 as an individual and $3,000 for a married couple outside of your countable assets. However, these amounts may vary depending on the state in which you live.
Your home, your car, personal belongings, or your savings for funeral expenses remain outside of countable assets. If you can prove other assets are not accessible , they too are exempt. A house must be a principal residence and does not count as long as the nursing home resident or their spouse lives there or intends to return there.
Upon becoming eligible for Medicaid, all of the applicant’s income must be used to pay for the nursing home where the applicant resides. However, you may be allowed to keep a monthly “allowance” and a deduction for medical needs, such as private health insurance. The amount of the allowance varies depending on your living arrangements, type of nursing facility, and state rules. If you are married, an allowance may be made for the spouse still living in the home.
Directory Of Assisted Living Facilities In Florida
Because finding the right facility can be difficult, we have simplified your research process by compiling our data into an easy to use directory. Below, you will find nearly 1,800 facilities in Florida listed with their relevant information, such as costs, amenities, and Medicaid acceptance status.
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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!
What Our Customer Say
My father has been in a Nursing Home for over 5 years when we realized that he was coming to the end of his resources. Then we heard about Medicaid Eligibility, Inc. We learned from the friendly and knowledgeable Nursing Home specialists how Florida Medicaid works and the options available to us.
We learned the balance of my fathers resources could be preserved, and he could become eligible to apply for Medicaid. Medicaid Eligibility was patient and helpful, and explained the application and approval process step-by-step. They filed all of the necessary paperwork on our behalf, and kept us informed throughout.
The kindness and consideration of the Nursing Home Medicaid Specialists to my fathers needs made the process easier for us so we could concentrate on other things. We dont know the laws, or how the laws can benefit us, so we are glad we turned to Medicaid Eligibility for our needs.
No one looks forward to having a family member enter a nursing home and few people completely understand all of the Medicaid eligibility requirements that can help them pay for it. At Medicaid Eligibility, Inc., we specialize solely in Florida nursing home Medicaid eligibility. That means you have the experts on your side when its time to prepare for paying on-going nursing home expenses.
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Difference Between Florida Medicaid Long Term Care Programs
Itâs important for my Medicaid-Planning clients to understand that âMedicaidâ is an umbrella term used for multiple programs. In a long-term care context, there are three primary Medicaid programs that Elder Needs Law, PLLC works with in Florida: ICP, Medicaid Waiver, or QMB for senior citizens age 65 or older, or disabled: The Medicaid Institutional Care Program and the Medicaid Waiver Program . QMB is short for: Qualified Medicare Beneficiary, which I will discuss below:
This article will discuss the differences between these three Medicaid long-term care programs.
How To Find Medicaid Assisted Living And Residential Care Homes In Florida
So, youll need to go to the site of awesomeness that I alluded to above, which is the Florida Health Finder site. Their site looks like this:
Immediately, youll be able to se a section for Assisted Living Facilities that takes you to some pretty cool and helpful stuff.
To find Medicaid assisted living facilities, jump to the Find and Assisted Living Facility section.
From there, youll need to select Search by Facility Type/Location which takes you to one of the best search tools for finding assisted living that I have ever used. It is comprehensive, and thorough, and lists every licensed facility in Florida. There are thousands!
Just put in Assisted Living Facility in to the first box, and then, type in your city, or zip code, or even county, and youll get a thorough list of facilities.
Youll need to go through and click on each facility to find the types of payments accepted. I dont know of a way to search or filter by Medicaid facilities.
Once you select a facility, youll see quite a bit of initial, very useful information.
Then, down below you will see under the services and characteristics section more really useful information. You should see a Payment Forms Accepted section, and youll likely see things like:
CHAMPUS, if you didnt know, is Civilian Health and Medical Program of the Uniformed Services.
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