FLORIDA MEDICAID FOR NURSING HOME Institutional Care Program (ICP) – Nursing Home Medicaid and Home Community-Based Waivers REQUIREMENTS Effective July 1, 2018

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 $126,420.00 (2019) 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 $910,438.00 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/$10,438.00)

INCOME LIMIT REQUIREMENTS OF APPLICANT – MEDICAID

• Monthly GROSS available income of applicant cannot exceed the State Income standard of $2,901.00 (2025 Cap).
• 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)

• 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 $730,000.00 (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 exmept 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.

State of Florida Medicaid Programs Available 2018 Nursing Home Institutional Care Program (ICP) Plus 10 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. 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 $1,325.00, Couple $1,783.00 (2025). Countable assets cannot exceed – Individual $9,660.00, Couple $14,470.00 (2025)
   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 $1,585.00, Couple $2,135.00 (2025). Countable assets cannot exceed – Individual $9,660.00, Couple $14,470.00 (2025)
   3. QI1 (Qualifying Individuals I – (Part B Medicare Only). Income exceeds 100% but less than 135% of Federal Poverty Level. Monthly Income cap – Individual $1,781.00, Couple $2,400.00 (2025). Countable assets cannot exceed – Individual $9,960.00, Couple $14,470.00 (2025).

QDWI – Workers Disabled program. Pays Medicare Part B premium. Must have lost SSDI due to employment. 200% of FPL. Monthly Income cap – Individual $2,609.00, Couple $3,525.00 (2025). Countable assets cannot exceed – Individual $5,000.00, Couple $6,000.00 (2025).