Florida Medicaid Eligibility
Nursing Home Medicaid Florida
Long-Term Care Medicaid
Why should I use Medicaid Eligibility Inc.?
Due to changes is the Medicaid eligibility guidelines, many people need assistance with correctly structuring finances and assets to take full advantage of the rules. With our coordination with an attorney we can help you that. We also help you with document collection and assist you filling with filling out your Medicaid application. In addition, we represent our clients at the scheduled Medicaid caseworker interview and present the application for approval and follow up on caseworker requests. Florida Nursing Home Medicaid FAQs.
What assets will Medicaid require spent down so I can qualify for eligibility?
Florida Nursing Home Medicaid FAQs
Cash, bonds, stocks, mutual funds, savings, property, life insurance cash values, and all other investment holdings. With prudent legal advice and planning from our work with a Medicaid attorney, you can preserve ALL of these assets.
Are there still planning options possible after I’ve entered a Nursing Home
Yes. It’s still possible to protect the bulk, or all, of your life savings and be eligible for Medicaid benefits even after you’ve entered a Nursing Home.
Are my spouse’s income and assets included if I apply for Medicaid?
While your spouse’s income is not included in determining your eligibility, your marital assets would be considered. However, income and savings above maximum limits can be protected, and Medicaid Eligibility, Inc.’s coordination with an attorney can show you how.
What assets are excluded from the Florida Medicaid eligibility asset test?
Homestead – The home is excluded if the spouse, or certain dependent relatives, continues to reside in the home, or the applicant intends on returning to the home.
Vehicle – One vehicle of any age may be excluded, along with a second vehicle if it’s over seven years old, and not an antique, luxury or custom model.
Life Insurance – If the total face value of all of the policies exceeds $2500, the cash value would be considered an asset. If the total face value of all of the policies is less than or equals $2500, then the cash value would be excluded as an asset.
Burial Funds and Prepaid Funeral Contracts – In an irrevocable burial contract, the full value is excluded regardless of the amount. There is also a $2,500 exclusion of funds designated for burial expenses. A new bank account (e.g. John Smith Burial Account) may be established for this purpose. In addition, one burial plot is permitted for each family member.
Personal / Household Goods – These are items within the home such as furniture
Retirement Accounts – Money in these accounts are not counted in the asset test as long as they are properly structured.
Immediate Annuities – As long as they are properly structured, annuities are excluded from the asset test. If the annuity is not structured correctly, the family may tie-up assets and be denied Medicaid benefits. This is an important reason to contact a knowledgeable Medicaid Eligibility Practitioner
Ongoing Business Concerns – Since they generate income for the applicant that is ultimately contributed towards the cost of care as patient responsibility, ongoing business concerns are typically excluded as assets. Another real property that is rented or listed for sale is also excluded. Florida Nursing Home Medicaid FAQs.
Medicaid vs. Medicare
Florida Nursing Home Medicaid FAQs
Since Medicare, a federal program, and Medicaid, a state and federal program, both provide health insurance benefits to the elderly, there exists much confusion about these two programs. Medicare is an optional health insurance program available to all Americans aged 65 or older. Stated very clearly, income and assets are not considered for eligibility purposes. On the other hand, Medicaid is health insurance specifically designed for low-income persons with limited financial resources.
It is possible to be eligible for both programs; these individuals are referred to as “dual eligibles”. Seniors who are enrolled in both programs generally have quite good health coverage. For instance, Medicare will not cover long-term care benefits, but Medicaid will. As an example, Medicare will cover nursing home care, but only on a short-term basis, up to 100 days. In contrast, Medicaid does not limit the number of days they will pay for nursing home care. In addition, Medicaid may pick up some of the out-of-pocket costs that Medicare does not, such as Medicare premiums and co-payments. Florida Nursing Home Medicaid FAQs.
Florida Nursing Home Medicaid FAQs. Waivers are state specific Medicaid programs that allow for services to be provided outside of nursing homes. The previously mentioned, Home and Community Based Services (HCBS) generally are provided via a type of Medicaid waiver. However, as mentioned above, some states do provide long-term HCBS through their state Medicaid program.
To avoid confusion, it is worth mentioning that waivers are also referred to as 1915 (c) waivers (because it is under section 1915 of the Social Security Act in which they are authorized), HCBS waivers, waiver services, waiver programs, and by any number of other state-specific names, such as the Pennsylvania Department of Aging (PDA) Waiver or the Washington Community Options Program Entry System (COPES).
A very important distinction between nursing home Medicaid and Medicaid waivers is that nursing home Medicaid is considered an entitlement program, while waivers are not. Entitlement, in this situation, means that if one meets the eligibility requirements, they are entitled to receive benefits. Said another way, they will automatically receive services. With Medicaid waivers, one might meet the eligibility requirements, but be unable to enroll in the program. This is because waivers limit the number of individuals who are able to receive services. Therefore, one may be put on a waiting list to receive benefits and is not immediately entitled to those benefits, given the program’s enrollment cap has been met. In addition, Medicaid waivers may limit their services to specific geographic regions within a state, as well as to particular medical diagnoses, such as Alzheimer’s disease. Florida Nursing Home Medicaid FAQs.
Florida Medicaid Planning For Long-Term Nursing Home Care
Florida Nursing Home Medicaid FAQs
Our Florida elder law attorneys are familiar with Medicaid benefits and Veterans benefits and can assist families struggling to pay for a loved one’s long-term nursing home expenses and preserve assets.
Often, spending down and going broke is not the only option for a family. Our Florida elder law attorneys know the ins and outs of Florida Medicaid laws and Veterans benefits laws. We know many perfectly legal techniques that may allow you to qualify for Medicaid benefits and Veterans benefits before you lose everything to long-term care expenses! We can assist you to protect and preserve assets even if your loved one is already in a nursing home. Florida Nursing Home Medicaid FAQs.
Medicaid laws are highly complex. So are the rules for Veterans benefits. Do not go it alone, as a mishandled application can result in the continued erosion of your assets. Before you take any action, be sure to consult with the certified elder law attorneys of The Karp Law Firm. Florida Nursing Home Medicaid FAQs.
Florida Medicaid Benefits Application: Documents Required to Apply
Florida Medicaid requires a large amount of documentation to determine whether an applicant will be approved for long-term care nursing home benefits. If the Medicaid applicant is married, the documentation is required for both the Medicaid applicant and the Medicaid applicant’s spouse. If you are downsizing your home or if you are an adult child helping to organize your parents, these items should be preserved!
Updated June 2017
Verification of all active savings accounts, checking accounts, CDs, stocks, bonds, IRAs, annuities, brokerage/investment accounts, etc.
- Monthly statements for the past five (5) years.
- Statements for all accounts that have been opened or closed within the applicable time period.
- Copies of all checks written in the amount of $500.00 or more for the last five (5) years.
- For annuities: full contract OR statement reflecting the purchase date, current value, surrender value, and death benefit.
Social Security card, Medicare card, Photo ID, Supplemental or Medicare HMO card, and Medicare D card.
Supplemental Health Insurance Premium Statement: If there is a community spouse, the premium statements must reflect how much is being paid by the applicant and how much is being paid by the spouse.
Income Verification Letter from Social Security. This is a letter from Social Security verifying the amount of the applicant’s Social Security income. If you do not have the one sent to you, it may be obtained by calling the Social Security Administration at 800-772-1213 (be sure to speak with a representative – do not leave a message on a recorder). The letter may also be obtained at:
Verification of date of birth. A birth certificate is usually best. If a birth certificate is not available, written verification of birth date may be obtained upon request from the Social Security Administration.
Proof of citizenship. Required only if the applicant was born outside the U.S.
Verification of pension income. All pension income must be verified from the source. Check stubs are sufficient when they reflect the gross amount received. You must provide a letter directly from the pension provider that verifies the gross, net, and any anticipated changes in the pension (such as whether the pension is fixed or if payment may vary).
Verification of gross monthly income from any other source. The letter directly from the source must be provided.
All insurance policies and insurance cards (copies). Life, accident, health, long-term care, home health care. If there is a life insurance policy, provide information from company verifying cash surrender value, if any.
Copies of guardianship or power of attorney papers, a copy of last will, copy of trust.
Income tax returns (including 1099’s) for the last five (5) years.
Car registration or title, and automobile insurance policy or proof of insurance card.
Copy of deed for any property owned, including homestead, and most recent property tax bill.
If any real property has been sold or transferred in the past five (5) years:
- Copies of all transactional papers.
- Two (2) verifications of fair market value, which may be an appraisal or a letter from a realtor.
- Property tax bill reflecting property’s value at the time of sale.
Burial arrangements. Copies of any purchase or agreements or any prepaid funeral contracts and/or cemetery or mausoleum plots, etc.
If an applicant or spouse is a veteran, V.A. discharge papers (DD214), and copies of marriage certificates for all marriages. If an applicant is the widow of a veteran, death certificate of the spouse.
Medicaid Qualified Income Trust (Miller Trust)
If a Medicaid applicant’s income exceeds the lawful amount for Medicaid eligibility ($2,250.00 effective Jan. 1, 2018), a Qualified Income Trust must be created with the applicant’s income in order to create eligibility for long-term nursing home care benefits. This instrument is also called a Miller Trust. This is an Irrevocable Trust.
The income of the Medicaid applicant which exceeds the eligibility criteria is placed in the Trust, and someone other than the applicant is the trustee. The Trust income will be disposed of in accordance with the directive of the Florida Department of Children and Family Services after the applicant has applied for Medicaid and been approved. Generally speaking, the applicant will be allowed to retain $105 per month of the income; may be entitled to divert some of the income to the community (well) spouse if the spouse’s income falls below $2030.00 per month (effective July 1, 2017); and pay a fixed amount towards his patient’s responsibility for nursing home care. In the event that there are excess funds in the account after the applicant dies, Florida Medicaid is entitled to reimbursement from those funds.
The Qualified Income Trust may be created by the applicant, if the applicant is competent to do so; by the applicant’s spouse, if there is one and if the spouse is competent to do so; or by the attorney-in-fact pursuant to the applicant’s Durable Power of Attorney, provided the Durable Power of Attorney authorizes the agent to do so. If none of the above conditions exist, a court proceeding would be necessary to secure the authority to create a Qualified Income Trust.
The Qualified Income Trust must be properly managed and payments must be made each month to maintain eligibility. There are very specific rules that must be followed for the trust. For example, it must be in a non-interest bearing account. Contact The Karp Law Firm for assistance and information about the Miller Trust. Our elder law attorneys are experienced in this complex area of the law. Florida Nursing Home Medicaid FAQs.
Medicaid Asset Protection Trust
Florida Nursing Home Medicaid FAQs
Our Florida Medicaid lawyers may recommend a Medicaid Asset Protection Trust for you if you:
- Are concerned about preserving assets for your spouse or other family members.
- May require Medicaid benefits for long-term nursing home care in the future, even if current health is not an issue.
- Do not have long-term care insurance, or have not taken any other steps to cover long-term care nursing costs.
- Have people you trust, such as adult children, who can serve as trustee(s).
A Medicaid Asset Protection Trust is an irrevocable trust. Properly managed and funded, after five years, all of the principal will be deemed an unavailable asset if you apply for Medicaid, and will be preserved for your family. Florida Nursing Home Medicaid FAQs.
HOW IT WORKS:
The Medicaid Asset Protection Trust is an Irrevocable Trust and can be a highly effective asset preservation strategy. It allows you, the “trustor,” to create the Trust and to name one or more persons – other than yourself or your spouse – to manage the Trust. You may give detailed instructions as to how the assets are managed. You may even retain the right to change the trustee at any time if the trustee is not managing the assets to your satisfaction, or for any other reason. Florida Nursing Home Medicaid FAQs.
You are entitled to all of the income, for yourself for your lifetime. You may also make the income available to your spouse. As trustor, you retain the right to direct the trustee to give gifts of the principal to your children or others, although no distribution can be made from the Trust to you. Of course, your children are free to use the principal as they see fit, including spending it on your needs
The Medicaid Asset Protection Trust generally pays income only to you, the trustor – for example, interest on CD’s or stock dividends – but limits your access to the principal. While assets placed in the Trust can be managed by the trustee and bought and sold as before, you and your spouse may not draw on the principal for your own needs. You can, however, direct your trustee to make gifts to other family members. Florida Nursing Home Medicaid FAQs.
You continue to have full use of any real estate placed in the Trust.
Although the Trust is irrevocable, you have the right to change the beneficiaries.
In the unlikely event that you ever need to terminate the Trust, you may do so if the trustees and beneficiaries agree.
The principal generally stays in the Trust until your death, at which point the Trust assets pass directly to your heirs, without the expense and delays of probate
You do not need to put everything you own into a Medicaid Asset Protection Trust. Our Florida Elder Law Attorneys generally recommend putting in only certain assets, such as liquid assets which are subject to capital gains and are drawing interest. As trustor, you can keep as much of your assets as you wish outside the Trust, in order to maintain your financial independence. Any assets that remain outside the Trust, however, should be held jointly or in a separate Living Trust (Revocable Trust) in order to avoid probate.
As you can see, The Medicaid Asset Protection Trust can be a highly effective asset preservation tool. It is also highly complex, and must be discussed with, and designed and drafted by a certified and experienced Florida elder law attorney. Florida Nursing Home Medicaid FAQs.
Florida Veterans Benefits Lawyers in Palm Beach, St. Lucie and Martin Counties
Our Florida veterans benefits lawyers advise disabled and elderly veterans and their surviving spouses about qualifying for benefits for long-term care. Pension with Aid and Attendance is a little-known veterans benefit and contrary to popular belief, this benefit is not service-connected. This benefit is available to eligible veterans and their widows/widowers to help pay for at-home care, nursing home care or assisted living care.
Our V.A.-accredited lawyers can advise you about eligibility requirements, as well as help you coordinate with your estate plan and other benefits to which you may be entitled in the future, for example, Florida Medicaid benefits for long-term care. Attorneys Joseph Karp and Adele Harris are admitted to practice in the United States Court of Appeals for Veterans Claims.
There are income limits for Aid and Attendance benefits. However, even veterans whose income exceeds the allowable amount may qualify if unreimbursed medical expenses, once deducted, bring the income below the maximum level. Florida Nursing Home Medicaid FAQs.
V.A. PENSION WITH AID & ATTENDANCE BENEFITS: ELIGIBILITY CRITERIA FOR VETERANS
- Veteran was discharged from service under conditions other than dishonorable.
- Veteran served at least 90 days of active military service, 1 day of which was during a wartime period (see Wartime Periods below).
- If veteran entered active duty after September 7, 1980, generally he/she must have served at least 24 months or the full period for which called or ordered to active duty (although there are exceptions to this rule).
- Veteran’s countable family income must be below a yearly limit set by law. However, unreimbursed medical expenses – which may include the cost of a nursing home or assisted living facility or in-home assistance, as well as other medical expenses – are deducted when calculating income.
- Veteran is age 65 or older, OR, permanently and totally disabled, not due to willful misconduct
- Allowable assets not to exceed $80,000 (effective Dec. 2013). Note that asset transfers are NOT considered.* For example, if you give $50,000 to your daughter on Tuesday and apply for V.A. benefits on Wednesday, the $50,000 transfer will not be held against you.*On Jan. 26, 2015, the V.A. introduced a proposal to establish a look-back period for asset transfers. If that proposal becomes law, many of the transfer, asset and income rules will change. For updates, check this website, our blog and subscribe to our monthly e-newsletter.
V.A. PENSION WITH AID & ATTENDANCE BENEFITS: ELIGIBILITY CRITERIA FOR VETERANS SURVIVORS AND DEPENDENTS
- Surviving spouse must not have remarried.
- Children must be under age 18, or under age 23 if attending VA-approved school or have become permanently incapable of self-support because of disability before age 18 (unless the child marries or income exceeds applicable limit).
- World War II: Dec. 7, 1941 – Dec. 31, 1946. Extended to July 25, 1947 if the Veteran was in service on December 31, 1946. Continuous service before July 26, 1947 is considered World War II service.
- Korean conflict: June 27, 1950 – January 31, 1955
- Vietnam era: August 5, 1964 – May 7, 1975 and from February 28, 1961 – May 7, 1975 in the case of a veteran who served in the Republic of Vietnam during that period.
- Persian Gulf: August 2, 1990 – yet to be determined.
- National Guard: does NOT count as Military Service unless under Title 32.
Benefits are retroactive to the first of the month the claim for benefits has been filed. There is a new federal policy where they may be able to go back 12 months for nursing home applications.
AVOID THE MEDICAID TIME BOMB
To determine eligibility, the Veterans Administration considers income and unreimbursed medical expenses. Asset transfers are not considered. For example, if you give $50,000 to your daughter on Tuesday and apply for V.A. benefits on Wednesday, the $50,000 transfer will not be considered. That’s a very different approach from Florida Medicaid, which carefully examines asset transfers. Currently, Florida Medicaid applies a five-year lookback period for transfers. Florida Nursing Home Medicaid FAQs.
Many veterans who apply for Aid and Attendance benefits will ultimately apply for Medicaid benefits. When you apply for Medicaid, those prior asset transfers may become a “Medicaid Time Bomb” resulting in a denial of Medicaid benefits.
To avoid the Medicaid Time Bomb, be sure to consult with our Certified Elder Law Attorneys before you apply for Veterans benefits. We can devise a coordinated approach that will allow you to secure the maximum Veterans benefits and Medicaid benefits you’re entitled to.