FLORIDA SSI-MEDICAID FOR NURSING HOME

Institutional Care Program (ICP) – Nursing Home Medicaid

and

Home Community-Based Waivers

REQUIREMENTS

Effective January 1, 2024

 GENERAL ELIGIBILITY

•  At least 65 years of age or defined as disabled pursuant to Social Security Administration definition.
• 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.

MEDICAL NEED REQUIREMENT

• Medicaid “medical need” for nursing home care must be established by the  Florida Department of Elderly Affairs (DOEA) – Comprehensive Care Assessment and Review for Long-Term Care Services (CARES) with a Level of Care (LOC) indicating a skilled nursing level of services is necessary.
• The CARES unit sends out a registered nurse or assessor to review the medical needs of each Medicaid applicant. The criteria used are based upon the “Activities of Daily Living” (Feeding oneself, ambulating, transferring, bathing, Continence, Toileting, and 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 $154,100.00 (2024) 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 an “ineligibility period”. There is a look-back for any transfers (gifts) made by the applicant or his/her spouse. The look-back period is 5 years.
• The penalty for disqualifying transfers is 1 month for every $10,809.00 of penalizing transfers. The penalty period will begin as of the date of the Medicaid application, where the applicant is otherwise eligible for Medicaid, but for the transferred assets. Penalties  are rounded to days (Gift/$10,809.00)

INCOME LIMIT REQUIREMENTS OF APPLICANT – MEDICAID

• Monthly GROSS available income of applicant cannot exceed the State of Florida Income standard of $2,829.00 in 2024.
• The Florida Department of Children and Families – Economic Self Sufficiency adult services unit administers and verifies the applicant’s income. There are guidelines they follow for determining what is and is not considered an applicant’s “Income”.

EXEMPT ASSETS (Medicaid does not count) – MEDICAID

• Homestead – Is an exempt asset so long as the Medicaid applicant “intends” to return home. There is a cap on the value of a Homestead. In Florida the cap equals $713,000.00 (This is fair market value less any outstanding mortgage balance). Note, if the homestead is lived in by a spouse, disabled child, or sibling who has resided there over 2 years and providing care to applicant, the value can exceed the equity value cap.
• Certain additional real property if it is being rented out at fair market value 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. In Florida, all vehicle over 7 years old are also exempt so long as not a luxury vehicle
• 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.

SUMMARY OF ALL SSI-MEDICAID RELATED PROGRAMS IN FLORIDA FOR THOSE OVER 65 OR DISABLED 

State of Florida SSI-Related Medicaid Programs Available in 2024 – With Full Benefits

1. Nursing Home Medicaid  a/k/a Institutional Care Program – ICP
2.  Medicaid for the Aged and Disabled (MEDS-AD) (Individuals who do not have Medicare, unless receiving ICP, Hospice, or Home Community Based waiver)
3. Program for All-Inclusive Care for the Elderly (PACE) (Current programs available in the following counties: Broward, Palm Beach, Charlotte, Clay, Collier, Duval, Hillsborough, Lee, Martin, Miami-Dade,  and Pinellas
4. Hospice
5. Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) – Home Community Based Waiver
6. Medically Needy (Available when one cannot qualify for Medicaid, but has high medical bills. Medical bills are submitted to Medicaid on a monthly basis and paid through this program)
7. Medicare Savings Programs – Florida Medicaid Programs related to paying Traditional Medicare premiums, co-pays deductibles)
   
   1. QMB – (Qualified Medicare Beneficiary). Pays Medicare Part A & B premiums, co-insurance, and deductibles only,  and one must be receiving Medicare Part A. Monthly Income cap – Individual $1,215.00, Couple $1,634.00 (2024) (Equals 100% of the Federal Poverty Level Monthly Income) . Countable assets cannot exceed – Individual $9,430.00, Couple $114,130.00 (2024)
   2. SLMB- (Special Low Income Medicare Beneficiary). Pays Medicare part B premium only. One must be receiving Medicare Part A.  Income exceeding 100% but less than 120% of Federal Poverty Level and one must be entitled to Medicare Part A to qualify. Program is designed for those whose monthly income exceeds 100% of the Federal Poverty Level but is less than 120% of Federal Poverty Level monthly Income cap – Individual $1,458.00, Couple $1,972.00 (2024). Countable assets cannot exceed – Individual $9,430.00, Couple $14,130.00 (2024)
   3. QI1 (Qualifying Individuals I – Pays Medicare Part B premium only. Program is designed for those whose monthly income exceeds 100% but is less than 135% of the Federal Poverty Level monthly Income cap – Individual $1640.00, Couple $2,219.00 (2024. Countable assets cannot exceed – Individual $9,430.00, Couple $14,130.00 (2024).
   4. QDWI – Qualified Disabled Working Individuals – Pays Medicare Part A premium only. Program is designed for those who lost SSDI due to employment and whose monthly income is less than 200% of the Federal Poverty Level cap – Individual
8. Breast and Cervical Cancer Treatment (BCC) (Must be under 65, U.S. citizen or qualified non-citizen, no health insurance covering services needed, and income below 200% of the Federal Poverty Level)

OTHER NON-MEDICAID PROGRAMS IN FLORIDA

1. Extra Help with Medicare Prescription Drug Costs (a/k/a Low-Income Subsidy – LIS)
2. Optional State Assistance (Indigent/No assets).
3. Community Care for the Elderly (No Income /asset test.  Must be age 60 or older. Wait list is very very long and program is full). Contact local county Aging Resource Center or Area Agency on Aging for additional information.
   

Home Care for the Elderly – Provides basic $160.00 subsidy for those age 60 and over. A basic subsidy is provided for support and maintenance of the elder, including some medical costs. A special subsidy may also be provided for services and/or supplies.

1. Gross monthly income under $2,829.00 for an individual and  Couple $2,866.00 (2024). Countable assets cannot exceed the nursing home level of assets  – Individual $2,000.00 (2024). 
2. SSI-Related Medicaid Programs with Limited Benefits