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5 Things You MUST Know About Florida Medicaid Planning

Sunshine, beaches, and grandkids are the retirement dream for many elderly Florida residents. But what many don’t realize is the high cost of long term care. Nursing home care is very expensive. In Tampa, nursing homes can cost an average of $9,000 to $11,000 per month, which can quickly deplete any savings, leaving you and your loved ones facing financial stress. 


Fortunately, Florida Medicaid can help cover most of the nursing home and other long-term care costs for Medicaid-qualified individuals, including room, meals, and medical supplies. A Florida Medicaid planning attorney can help strategically structure your assets and income to qualify for Medicaid.


 What is Florida Medicaid?

For those unfamiliar, Medicaid is a joint federal-state health insurance program that offers a lifeline to low-income individuals and families, including children, pregnant women, seniors, and people with disabilities. In Florida, Medicaid is administered by the Agency for Health Care Administration, with eligibility determined by the Department of Children and Families or the Social Security Administration.


Now, what exactly does Fl Medicaid cover? The program covers nursing home costs, long-term care, hospital stays (both in and outpatient), doctor visits, family planning services, lab tests, x-rays, health screenings for young people under 21, and even transportation to access these covered services.


Medicaid vs. Medicare

Now, you might be thinking, “Isn’t that what Medicare is for?” Here is the key difference. Medicare is an age-based program primarily targeting Americans 65 and over, or those under 65 with disabilities, regardless of income. Medicaid, on the other hand, is income-based, providing health coverage to those who have a very low income.


 What is involved in the Florida Medicaid planning process?

Medicaid planning is about strategically structuring your assets and income to shield a portion of them from being counted towards eligibility. Florida Medicaid has a look-back period of five years for asset transfers. This means the State Medicaid office scrutinizes any large gifts or asset transfers you have made in the past five years to prevent you from artificially lowering your assets to apply for Medicaid benefits. A Florida Medicaid planning attorney, estate planning and elder law can guide you through the formation of Qualified Income Trust also known as a Miller Trust to help you meet the asset eligibility criteria for long-term care Medicaid, even if your income falls outside the standard limits. With Medicaid planning, you can increase your chances of qualifying for Medicaid benefits, allowing you to keep more of your hard-earned money for yourself, your spouse, and your loved ones.


Who is eligible for Florida Medicaid?

In Florida, one’s Medicaid eligibility is determined based on residency, citizenship or qualified alien status, income, and assets. Here’s what you need to know:


To become eligible for Medicaid, you must be a Florida resident, U.S. citizen, qualified alien (legal permanent resident for at least five years), or documented non-citizen facing a medical emergency whose financial situation meets the Medicaid income threshold. You should be prepared to show proof with documents like a passport or green card, valid Florida ID, or utility bills to help establish your citizenship and residency. 


Fl Medicaid eligibility rules provide coverage for expecting mothers with a family income up to 196% of the Federal Poverty Level (FPL), and children aged 0-1 can qualify with a family income up to 206% of the FPL. Parents or caretakers who are responsible for a child 18 years of age or younger, Blind or Disabled Individuals or if you have a disabled family member in your household, Former foster care Individuals, Aged or disabled individuals not currently receiving Supplemental Security Income (SSI) and individuals aged 65 years or older eligible for Medicaid in Florida. 


Elderly or disabled individuals who already receive Supplemental Security Income (SSI) are automatically enrolled in Medicaid, regardless of their income. The income cap for SSI recipients in 2024 is generally $943 for an individual and $1,415 for a couple. 


Qualified individuals can make a Medicaid application only for ‘medically necessary’ health care services. The requirement for ‘medical necessity’ ensures Medicaid is not funding elective procedures.


Who is not eligible for Medicaid in Florida?

Florida has not expanded eligibility for Medicaid under the Affordable Care Act (ACA). This means adults under the age of 65 without dependent minor children or a disability do not qualify for Medicaid regardless of how low their income.


What is Florida Medicaid income/asset limit? 

There is no one-size-fits-all income limit for Florida Medicaid. Medicaid limits can vary depending on your household size and the specific Medicaid program you’re applying for. There are different programs for things like nursing home care, children’s health, and pregnancy.


Medicaid also has limits on countable assets, which include things like cash, stocks, and investment accounts. However, there are also exempt assets that don’t count, such as your primary residence, a vehicle, and reasonable household belongings. If you have life insurance or other health insurance, it won’t disqualify you from applying for Medicaid coverage. In fact, Medicaid can act as a secondary insurance, filling in the gaps where your primary plan falls short.


Does Medicaid Pay for Nursing Homes or Assisted Living? 

The short answer is yes. Fl Medicaid coverage extends to nursing homes and assisted living through the Statewide Medicaid Managed Care (SMMC) Long-Term Care Insurance. Access to Medicaid often involves a waitlist and the state’s Medicaid waitlist can be especially long for those already residing in assisted living facilities (ALFs) or receiving home care. However, there is a “back door” Medicaid planning strategy to bypass the ALF waitlist. Here’s how it works: your loved one might initially qualify for Medicaid by staying in a nursing home for a set period (usually 60 days). After they meet the eligibility requirements, they could transition to an assisted living facility while still receiving Medicaid support. It is important that you seek legal advice from an elderlaw attorney to ensure it’s the right course of action for your specific situation.


Florida Medicaid covers 100% of nursing home care received at a Medicaid-certified nursing facility for eligible individuals, yet many Medicaid recipients are required to pay his or her share of care costs for Medicaid long-term care benefits. This is called “patient responsibility”. The amount is determined by the Agency for Health Care Administration and considers the resident’s income after subtracting allowances for basic needs, health insurance premiums, and spousal support. Nursing homes may try to collect more than the allowed amount, and an elderlaw attorney or a Medicaid planning attorney may be able to help ensure you pay the correct amount.


Get Expert Florida Medicaid Planning Today! 

Are your assets or income too much to become eligible for Florida Medicaid? Our expert Florida Medicaid planning attorneys can guide you through the Medicaid planning process and answer your questions about Medicaid eligibility. Contact our law office today to get your Medicaid approved.