Boynton Beach Office: 561-347-1071

Medicaid basics

Are you in a nursing home and

  • Private paying for nursing home care?
  • Receiving rehabilitation in a nursing home under Medicare?
  • Has the nursing home told you  “Your Medicare skilled rehabilitation coverage is ending? or,
  • You have reached maximum medical improvement? or,
  • Plateaud?

Its time to call an elder law attorney to help guide you.

This is where I hope to make a difference. Help people get additional rehab they may need. It makes me feel good to know I helped someone during this family crisis when no one else seems to understand.” – Gregory Glenn, Certified Elder Law Attorney.

Medicaid Basics in Florida Once Medicare Skilled Rehabilitation Terminates

Medicaid Basics 65+

This page is dedicated to providing a brief outline of eligibility criteria and some of the programs available in Florida. Once the nursing home tells a patient the Medicare Part A skilled rehabilitation is ending because he/she has plataued or reached maximum medical improvement (MMI) its time to call Gregory Glenn for help.
See also Medicaid Planning page on this website for more information.

 

Medicaid Nursing Home Over Age 65 Florida Eligibility Criteria Overview 2017
  • Gross Monthly Income Limit of $ 2,205.00 in 2017
  • Personal Needs Allowance of $105.00 per month
  • Medicaid Countable Asset Limit $2,000.00 for Applicant
  • Community Spouse Resource Allowance (if married) $120,900.00 in 2017
  • Community Spouse Monthly Minimum Maintenance Allowance $2,003.00 per month (July 1, 2016 to June 30, 2017)
  • Community Spouse Maximum Monthly Maintenance Needs Allowance $3,002.50 per month
  • Excess Shelter Cost $601.00 maximum per month (July 1, 2016 to June 30, 2017)
  • Utility Allowance for calculated Community Spouse Income Allowance $337.00 per month.
  • Long Term Care Nursing Home Diversion Personal Needs Allowance $198.00 per month in 2017

FLORIDA MEDICAID NURSING HOME

INSTITUTIONAL CARE PROGRAM (ICP)

REQUIREMENTS

Effective January 1, 2017

 

GENERAL ELIGIBILITY
  • At least 65 years of age or disabled
  • Citizen of United States or an alien who has been admitted as a permanent resident
  • Resident of Florida. Anyone residing in a nursing home which is certified for Medicaid is considered to be a resident of Florida
  • Medicaid “medical need” for nursing home care has been established by the  Florida Department of Elderly Affairs (DOEA) CARES with a Level of Care indicating skilled nursing level of services is necessary.

MEDICAL NEED REQUIREMENT

  • Determined by the Department of Elderly and Veterans Services CARES unit and is based on Activities of Daily Living (Feeding oneself, transferring, bathing, Continence, Toileting, Cognitive abilities). To be eligible for  long-term care Medicaid a person must have a Level of Care assigned by CARES indicating a skilled level of care is necessary.   

ASSETS REQUIREMENTS – MEDICAID “COUNTABLE ASSETS”

  • Individual applying for ICP Medicaid – Countable assets of less than $2,000 in at least one day of each month of Medicaid eligibility.
  • Married and one spouse applying for ICP Medicaid – Applicant cannot have over $2,000 in assets. Community spouse can have up to $120,900 (2017) in countable assets in his/her name.
  • Both spouses applying for ICP Medicaid – Countable assets cannot exceed $3,000
  • Transfers of assets for less than fair market value (a gift) creates a possibility for ineligibility period. There is a look-back for any transfers (gifts). The look-back period is 5 years.
  • The penalty for disqualifying transfers is 1 month for every $8,662.00 of penalizing transfers. The penalty period will begin as of the date of application, where the applicant is otherwise eligible but for the transferred assets. Penalties  are rounded to days (Gift/7995.00)

INCOME LIMIT REQUIREMENTS OF APPLICANT – MEDICAID

  • Monthly GROSS available income of applicant cannot exceed the State Income standard of $2,205.00 (2017 Cap).
  • The Florida Department of Children and Families – Economic Self Sufficiency adult services unit administers and verifies this information. There are guidelines they follow for determining what is and is not considered an applicants “Income”

EXEMPT ASSETS (Medicaid does not count)

  • Homestead – so long as the applicant “intends” to return home. Also a homestead lived in by a spouse, disabled child, or sibling who has resided there over 2 years and providing care to applicant. The applicant can have up to $560,000 (2017) in equity in the homestead. Any amount of equity in excess of this is considered a countable resource. This cap does not apply if a spouse or other qualified dependent lives in the home.
  • Certain additional real property if rented or listed for sale at fair market value.
  • Certain property used in trade or business.
  • Certain Income producing property.
  • One Vehicle – regardless of age or value used to transport applicant for medical reasons
  • Term Life insurance
  • Life insurance – with current cash surrender value up to $2,500.00 – or if the total face value of all life insurance policies is less than $2,500;
  • Irrevocable burial/funeral contracts (unlimited value). Note, under Florida probate code, $6,000 is considered a reasonable amount for funeral costs.
  • Burial set aside funds up to $2,500 designated for burial expenses – Includes revocable burial contracts, bank accounts designated for burial by notation in the title, or life insurance policies with designation to pay burial costs.
State of Florida Medicaid Programs Available 2017 Nursing Home Institutional Care Program (ICP) Plus
9 other Medicaid State Funded Home and Community Based Waiver Programs
  • The ICP Program (Nursing Home)
  • 1. Statewide Medicaid Managed Care LOng-Term Care (SMMC LTC) Waiver
  • 2. Program for All-Inclusive Care for the Elderly (PACE) Palm Beach County as well as Charlotte, Collier, Lee, Miami-Dade,  and Pinellas County
  • 3. Channeling Program (Over 65) – 2 Hours/day custodial care, Day Care voucher, contract caregivers. (Miami-Dade and Broward County Florida only)
  • 4. I Budget Waiver
  • 5. Familial Dysautonomia Waiver
  • 6. Traumatic Brain Injury/Spinal Cord Injury Waiver
  • 7. Model Waiver (Formerly the Katie Beckett/Spino-Cerebral Disease – Children)
  • 8. Project AIDS Care (PAC) Waiver
  • 9. Adult Cystic Fibrosis Waiver
  • 10. Supported Living Waiver
Other Programs
  1. Medically Needy (Available when one cannot qualify for Medicaid, but has high medical bills. Medical bills are submitted to Medicaid and paid through this program)
  2. Hospice (Same eligibility criteria as ICP – nursing home Medicaid for asset and income levels.)
  3.  Alzheimer’s Disease Initiative (Run out of SE/SW Focal Point – Broward)
  4. Optional State Assistance (Indigent/No assets)
  5. Community Care for the Elderly (No Income /asset test. Wait list is very very long and program is full)
  6. Medicaid Programs related to paying for Medicare
    1. QMB – (Qualified Medicare Beneficiary) Income cannot exceed 100% of Federal Poverty Level and must be receiving getting Medicare Part A. Monthly Income cap – Individual $1,005.00, Couple $1,354.00 (2017). Countable assets cannot exceed – Individual $7,280.00, Couple $10,930.00 (2017)
    2. SLMB- (Special Low Income Medicare Beneficiary) Income exceeding 100% but less than 120% of Federal Poverty Level and one must be entitled to Medicare Part A to qualify. Monthly Income cap – Individual $1,206.00, Couple $1,624.00 (2017). Countable assets cannot exceed – Individual $7,280.00, Couple $10,930.00 (2017)
    3. QI1 (Qualifying Individuals I – (Part B Medicare Only). Income exceeds 100% but less than 135% of Federal Poverty Level. Monthly Income cap – Individual $1,357.00, Couple $1,827.00 (2015). Countable assets cannot exceed – Individual $7,280.00, Couple $10,930.00 (2017).
    4. QDWI – Workers Disabled program. Pays Medicare Part B premium. Must have lost SSDI due top employment. 200% of FPL. Monthly Income cap – Individual $2,010.00, Couple $2,707.00 (2017). Countable assets cannot exceed – Individual $4,000.00, Couple $6,000.00 (2017).

Gregory G. Glenn, Esq. is a Certified Elder Law Attorney by the National Elder Law Foundation. He has practiced elder law since 1995. Prior to law school Mr. Glenn worked as a management consultant at the Big Eight accounting firm of Coopers & Lybrand, CPA’s and also at Dunn & Roth, CPA’s as a staff accountant. He has his law degree from MSU and completed his legal studies at the University of Miami School of law. His focus in elder law is on estate planning for the over 65, disability planning, probate, and Medicaid eligibility planning. His office is in Boynton Beach, Florida.