Medicaid Penalties In Florida
Medicaid applicants in Florida can have their benefits delayed or denied if they willfully transferred any assets to their loved ones in the five years prior to submitting their Medicaid application. These uncompensated transfers are categorized as gifts, and they can have a major impact on a persons Medicaid eligibility.
Because Medicaid applicants are required to meet certain income and asset limits, its not uncommon for some seniors to transfer their asset in an effort to qualify for coverage. To deter this, Medicaid has established penalties for those who try.
If a person makes uncompensated transfer during their look-back period, Medicaid will not approve coverage until the persons penalty period ends. Medicaid determines a persons penalty period by dividing the number of gifts theyve given during the look-back period by $8,944, which results in the number of months Medicaid will wait before they step in.
Its important to note that there is no exception for small gifts, such as Christmas presents, when Medicaid calculates penalties. They assume all uncompensated asset transfers during the look-back period are done in an attempt to qualify for Medicaid, making it especially crucial for seniors to do careful Medicaid planning before they transfer any assets.
Free Assisted Living Resources In Florida
Florida is home to a number of nonprofit organizations and government programs that offer free aid to seniors in need of long-term care.
Florida Area Agencies on Aging
There are 11 Area Agencies on Aging in Florida that operate as Aging and Disability Resource Centers. The Department of Elder Affairs maintains a list of each resource center with current contact information. These centers have information about long-term care and access to any services available to Florida seniors.
5090 Commerce Park Circle, Pensacola, FL 32505 494-7107
2414 Mahan Drive, Tallahassee, FL 32308 488-0055
100 SW 75th Street, #301, Gainesville, FL 32607 378-6649
10688 Old St. Augustine Road, Jacksonville, FL 32257 391-6600
9549 Koger Boulevard, Gadsden Building, Suite 100, St. Petersburg, FL 33702 570-9696
8928 Brittany Way, Tampa, FL 33619 740-3888
988 Woodcock Road, Suite 200, Orlando, FL 32803 514-1800
15201 North Cleveland Avenue, Suite 1100, North Fort Myers, FL 33903 652-6900
4400 North Congress Avenue, West Palm Beach, FL 33407 684-5885
5300 Hiatus Road, Sunrise, FL 33351 745-9567
760 NW 107th Avenue, Suite 214, 2nd Floor, Miami, FL 33172 670-6500
For Florida seniors who have served in the U.S. military, local VA centers are available to help navigate government programs set up to provide assistance to veterans and their families. VA representatives are trained to answer questions, assist in understanding the types of care available and determine eligibility.
How Long Does It Take To Get Medicaid In Florida
The length of time it takes to receive Medicaid depends upon the type of benefit needed. For instance, individuals applying for family-related Medicaid through the Florida Department of Children and Families usually receive a determination within thirty days , while someone needing long-term care may have to wait months, or even years.
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Benefits And Services Provided By Florida Long Term Care Medicaid
All Florida Medicaid long-term care plans cover an array of medically-necessary services, in addition to normal Medicaid health insurance services and in addition to the home health agency, ALF and nursing home bill payments. The full Statewide Medicaid Managed Care Long-Term Care Program Coverage Policy can be found at the link. On page four, youâll find all the Home and Community Based Care services that can be provided for those who do not yet need nursing home care. Some of the services that Florida Medicaid LTC must cover for those who wish to age at home but who need assistance are:
Adult Companion Care: this is for non-medical care when needed to protect the health, safety and well being of LTC medicaid recipient. This includes help with common household chores, such as light housekeeping, laundry, and meal preparation. If someone is needed to administer medications, this can also be provided. As a corollary to this service, when a Florida long-term care medicaid enrollee has someone to assist with these duties, and THAT person is temporarily unavailable, these homemaker services can be obtained, on a short term basis, at no extra cost.
In addition, short term respite care can be provided when the usual caretaker is in need of a break/vacation. Sometimes, a family caregiver has to work and so it would make sense to request a care plan that includes regular visits to an adult day care center.
âDental / Vision / Hearing Care.â
What Are The Average Costs Of Senior Living Homes In Florida
According to Genworths 2019 Cost of Care Survey, Floridas average cost of assisted living is $3,500 per month. While prices vary greatly across the state, the average low is $2,836 per month, and the average high is $5,375 per month.
Miami, Tampa, Punta Gorda, and Sebastian are some of the states most affordable areas for assisted living. Approximately $2,836 $3,375 is the monthly average cost in these regions.
Gainesville, Lakeland, and Port St. Lucie offer fairly reasonable living conditions with an average monthly cost consistent with the state average. Typically, these areas are between $3,463 and $3,500 in price.
Assisted living is most expensive around Panama City, Deltona, and Tallahassee. Prices are between $4,500 and $5,375 per month.
For seniors with Alzheimers and other severe conditions, the cost of assistance is often more. It is usually about 20%-30% more expensive for Alzheimers patients to reside in an assisted living facility.
The cost of Alzheimers and memory care in Florida assisted living communities generally ranges from $709 to $1,343 per month. This is because these types of care provide a higher level of supervision and security.
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Does Medicaid Pay For Assisted Living
While Medicaid does not directly pay for assisted living, those eligible for the waiver can receive reimbursement for assistance with the activities of daily living. As part of our policy on transparency, we always share our prices online. Residents choose from apartments or suites and different tiers of assisted living programs.
If you need assistance determining the level of care and room type for yourself or an elderly loved one, we are happy to answer any questions you may have.
Who Can Get Medicaid Assistance For Assisted Living
While the federal government requires Medicaid to cover low-income adults over 65, as well as those who are blind or have a disability, states themselves get to decide what criteria to use to determine someones eligibility.
Requirements are typically based on someones resources, but states have different thresholds for how much a person can have in savings or assets before enrolling in Medicaid. In some cases, states will adjust those thresholds to account for dependents or spouses who dont require assisted living. Even so, seniors generally have to deplete almost all of their savings before being eligible to receive assisted living benefits through their states Medicaid program.
Visit Benefits.gov or your states Medicaid website for more information on eligibility requirements and how to enroll.
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Why Choose The Cabana At Jensen Dunes
As a Florida senior living community with a focus on holistic wellness, we take great strides to ensure residents have a supportive lifestyle for an affordable price. The Cabana at Jensen Dunes provides all-inclusive assisted living starting at just $4,389 per month and Valeo memory care starting at $6,374.
Contact us to learn more about the pricing for senior living in Port St. Lucie. No matter your care needs, we pride ourselves on individual attention, a family-oriented atmosphere, custom services and first-class amenities that rival all other senior living communities in the Jensen Beach and Stuart areas. This makes life at The Cabana at Jensen Dunes an exceptional value.
To Qualify For Medicaid Assistance For Nursing Home Expenses You Must:
- Reside in Florida
- Be a U.S. national, citizen, or have satisfactory immigration status
- Need health care and insurance assistance
- Meet certain low income and asset tests and
- Be one or more of the following:
- be age 65 or older
- pregnant or have a child 18 or under
- blind or disabled or have a blind or disabled spouse, child, or parent living in your household.
Florida Medicaid applicants 65 or older must have a limited income and assets to qualify for Medicaid coverage however, there are ways for some seniors to transfer their money and property to become eligible. In situations such as these, it is important to take extra precaution, as the applicant may need funds for future nursing home care, and the transfer could make them ineligible or delay their ability to collect benefits.
At our firm, we help clients to the extent possible in seeking the maximum Medicaid benefits to which they may be entitled through long-term Medicaid planning, asset transfers, and other strategies for those who will soon be going into a nursing home, as well as those who may already be in a nursing home.
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How Does The Wait List Work
The HCBS wait list takes the sickest individuals first. Referrals are made to your local Aging Resource Center , such as this one in Pinellas County, who manages the wait list. It does not hurt to try to place your elder on the wait list if they are needing more and more help as they age. The elder does not need to qualify for Medicaid financially to be on the waitlist, importantly. If the elder comes off the wait list, you would likely see a good elder law attorney if the income/assets were over the bare minimum.
If your elder is on the HCBS wait list, you would want to inform your Aging Resource Center of any change in health changes, falls, trips to the hospital, etc. Moving up the list likely means that the elder will need to be in a nursing home within the next 3 months, so a change in health may help him or her move up the wait list. A good elder law attorney can also be very helpful in moving the applicant up the wait list under as the attorney can help advocate while looking at the areas of health care priority. As in anything in life, an informed elder law attorney can be invaluable.
Get The Insights You Need To Find The Right City
Families looking for assisted living in Florida have a wide array of communities to choose from, since estimated that there are more than 30,000 assisted living communities serving seniors across the U.S., and over 1,776 statewide. The state is also home to a rapidly growing number of senior citizens, with adults over 65 making up an estimated 20.1 percent of the population. A resident in an assisted living community in Florida will pay $3,500 per month on average.
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How Do You Become Eligible For Medicaid
For someone to become eligible for Medicaid, their income must be below the poverty line. Some groups of the population are considered mandatory for approval, which includes:
- Pregnant women
- Children living 133% below the poverty line
- Those receiving SSI benefits
- Seniors 65 and older living under the poverty line
As a result of the Affordable Care Act, a new method to calculate income eligibility has been created: Modified Adjusted Gross Income .
This method determines the financial eligibility for the Medicaid and CHIP programs. MAGI also determines the tax credits and reductions in the health insurance market.
Following this one method allows people to become eligible for Medicaid easier. Also, more people can now receive health insurance.
Medicaid eligibility now takes into account taxable income and filing relationships. Contrary to the methods of the program that ended in 1996, the MAGI methodology does not disregard income that varies by state, eligibility group, or property.
Memory Care In Florida
According to the Alzheimers Association, Alzheimers disease ranks as the sixth leading cause of death in Florida, which parallels national death rates related to this degenerative form of dementia. In 2015, 7,031 Floridians died from Alzheimers-related complications, and its estimated that more than a half-million Florida residents aged 65 and older have the disease. Nationwide, the Centers for Disease Control and Prevention projects rates of Alzheimers and other forms of dementia will nearly triple, impacting an estimated 14 million Americans by 2060.
Memory care facilities provide those living with Alzheimers and dementia with care that is tailored to their unique needs. Memory care can take place in its own facility, or as part of a designated wing of another residential care community. Staff members of memory care units or facilities undergo specialized training in caring for those with memory impairment, and the facilities often coordinate social activities and schedules specifically for the needs of those living with Alzheimers or dementia.
This guide will cover the cost of memory care in Florida, financial assistance options for paying for memory care, free memory care resources in the state, and a directory of memory care facilities in Florida.
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What Are The Benefits Of Medicaid For Senior Living In Florida
The Medicaid program provides a way for families to provide proper care for their elder loved ones. As healthcare cost continues to rise, many seniors struggle to afford their medication and additional assistance.
In caring for the elderly, prescription drugs account for a significant portion of the cost. Recent data reports, that the average amount spent on prescription medications by those 65 and older is over three percent of their income.
The rate increases even more if you include over-the-counter medicines. Many adults choose not to take their medication to avoid buying the high cost risking them becoming sicker.
Medicaid allows this not to happen and ensures seniors can afford their medicine to stay healthy. In addition, there are benefits for the elderly living in senior living communities.
Aside from receiving the necessary care, they also have an opportunity to connect with those their own age. Assistive living communities offer an array of amenities and activities designed to help the elderly stay active and engaged.
How To Apply To Medicaid In Florida
Medicaid applications are reviewed by the Department of Children and Families in Florida. There are three primary ways to apply to Medicaid:
- In-person, at a local DCF branch
- Online, using the MyACCESS portal
- Over the phone, by calling 866-762-2237
If a person is moving from another state to Florida, they must re-apply for benefits regardless of any Medicaid coverage they had in their previous location. SSI recipients are automatically considered for Medicaid coverage in Florida, however they must submit a separate ACCESS application if they are applying for long-term care benefits.
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Florida Unitedhealthcare Assisted Living Plan
UnitedHealthcare Assisted Living plans are Institutional Special Needs Plans for members who live in a contracted assisted living facility and require an institutional level of care. These plans do not require referrals for specialty care.
- UnitedHealthcare Assisted Living Plan
- UnitedHealthcare Assisted Living Plan
Health Maintenance Organization plans have a defined network of contracted local physicians and hospitals to provide member care. Generally, members must use these care providers to receive benefits for covered services, except in emergencies.
Point of Service plans include all the features of HMO plans plus the ability to go outside the contracted network for certain health care services typically at a higher cost.
Preferred Provider Organization plans work with a network of contracted local physicians and hospitals, but also allows members the flexibility to seek covered services from outside of the contracted network, usually at a higher cost.
UnitedHealthcare offers Medicare Advantage Special Needs Plans that combine the hospital and doctor coverage of Medicare Parts A and B with Part D prescription drug coverage, plus additional benefits and services designed to meet the unique needs of identified Medicare consumer populations.
Tools and Resources UnitedHealthcare® Assisted Living Plan
The Senior Legal Helpline
The Department of Elder Affairs maintains a helpline for seniors in need of advice regarding civil law. The helpline is free to use, and provides appointment scheduling to people over 60 years of age who wish to speak with a Florida legal professional over the phone. Services that the helpline provides include free legal advice and briefing, referrals to state and local regulatory agencies, and help finding legal council when court representation is needed.
The Senior Legal Helpline can be reached by calling 895-7873. To find out more, visit ElderAffairs.state.fl.us.
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Ready To Learn More About Senior Living Florida With Heidis Haven
During the retirement stage of ones life, one should not have to worry about the risk of homelessness or how to pay for healthcare. Senior living communities in Flordia offer a way for the elderly to live peacefully and safely in a comfortable environment.
Also, Medicaid is a way for low-income elders to pay for their medications and healthcare cost.
Heidis Haven is a senior living in Flordia that accepts Medicaid and works with its residents to find ways to cover other expenses. To learn more about senior living Flordia, contact us for our services.
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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