To qualify for Medicaid assistance for nursing home expenses, you must:
Reside in Florida;- Be a U.S. national, citizen, or have satisfactory immigration status;
- Need health care and insurance assistance;
- Meet certain low income and asset tests; and
- Be one or more of the following:[1]
- be age 65 or older;
- pregnant or have a child 18 or under;
- blind or disabled; or have a blind or disabled spouse, child, or parent living in your household.[2]
Florida Medicaid applicants 65 or older must have a limited income and assets to qualify for Medicaid coverage; however, there are ways for some seniors to transfer their money and property to become eligible. In situations such as these, it is important to take extra precaution, as the applicant may need funds for future nursing home care, and the transfer could make them ineligible or delay their ability to collect benefits.
At our firm, we help clients to the extent possible in seeking the maximum Medicaid benefits to which they may be entitled through long-term Medicaid planning, asset transfers, and other strategies for those who will soon be going into a nursing home, as well as those who may already be in a nursing home.
How is Medicaid for Seniors Administered in Florida?
Almost seventy percent of all individuals over 65 will need long-term care services.[3] Medicaid is a joint federal and state program that provides healthcare coverage to over 72.5 million Americans (which amount to about 20% of the population of the US).[4] As noted above, those covered by Medicaid include both seniors and non-seniors with limited means.
The federal government sets Medicaid policies and contributes money to the Medicaid fund of each state, while each state (including Florida) manages its own program. Consequently, Medicaid regulations vary from state-to-state, making the application process more complicated.
As an experienced Medicaid planning law firm, we are well versed in the intricate laws associated with the Florida Medicaid program and can help navigate the complexities of the application process to increase the chances of securing a favorable benefit determination.
How Much Do Nursing Homes Cost in Florida?
In Florida, the cost for long-term care can be significant. In 2019, for instance, the monthly median costs in Florida for certain healthcare services was:
- Assisted Living:
- Adult Day Care $1,473
- Assisted Living Facility $3,500
- In-Home Care:
- Homemaker Services $4,004
- Home Health Aide $4,195
- Nursing Home Care:
- Semi-Private Room $8,547
- Private Room $9,387[5]
For low-income Florida seniors without health insurance or whose insurance does not cover their needs, Medicaid provides financial assistance for healthcare and related expenses. However, it is not just those in low-income who will be greatly affected by the high costs for nursing home care; such costs can also quickly wipe out the life savings of middle-class households.
Seeking Medicaid benefits can often make the difference in a couple being able to retain their house and some assets vs. going broke paying for nursing home costs.
Do I Need a Lawyer for a Medicaid Application?
In cases where an individual has little or no income, minimal assets, and needs only community benefits (benefits taking place outside of a residential setting), filing a Medicaid application may be relatively straightforward. However, if even moderate assets are involved, or if a senior needs assisted living or nursing home care, an experienced Medicaid planning attorney should be retained, as effective Medicaid planning is often complex.
Having an experienced elder law attorney by your side can make a profound impact on whether you secure benefits or have to pay for care out-of-pocket. The following are a number of factors to consider when deciding whether to retain an experienced Medicaid attorney:
- An experienced Medicaid attorney will be looking out for your best interests (not that of a nursing home). Individuals who prepare Medicaid applications (on behalf of nursing homes or care companies) have a duty to those companies to make arrangements that are favorable to the institution, not to the resident. In some cases, a resident and a nursing home may have overlapping objectives; but this is not always the case. Nursing homes typically desire for residents to pay privately for as long as possible prior to collecting Medicaid. As such, individuals hired by these companies may not proceed in a timely manner that ensure the senior personally pays the least amount possible.
- Experience can lead to better outcomes. Attorneys who regularly work with seniors develop a depth of knowledge about the Medicaid process that allows them to provide knowledgeable and strategic guidance that may not be otherwise provided by someone lacking experience in the field. At the Flammia Elder Law Firm, we help clients achieve their objectives, whether it be maintaining independence, preserving assets for their loved ones, or securing assisted living or nursing home care.
- Those using a Medicaid attorney will often save significant money compared to those who file on their own. Medicaid planning can often be complex. A small mistake or not fully taking advantage of the possibilities available can be costly.
- Using a Medicaid attorney may result in receiving benefits earlier. In Florida, the average nursing home stay costs almost $10,000 per month;[6] however, in many cases, private accommodations can cost upwards of $15,000 to $20,000. Legal fees are typically much less than a single month of nursing home care, and an experienced elder law attorney can often help individuals save tens of thousands of dollars.
- We provide peace of mind. Not knowing whether you have exhausted all your options can be unsettling. When you retain our firm, you can rest easy knowing that one of our experienced Medicaid lawyers will review your case and ensure that you receive all benefits that you are rightfully entitled to.
Medicaid applications for nursing home benefits are often subjected to stricter scrutiny by Medicaid personnel; as a result, a showing of up to five years of financial records and extensive documentation may be required.
Transfers to family members or various family care agreements may further complicate the process, as any unexplained expense may be treated as a disqualifying event or cause a delay in the application review process. As experienced Florida Medicaid planning lawyers, our attorneys can guide you through the complexities of the application process, provide advice on how to avoid delays, and help you or a family member seek to qualify for benefits as early as possible.
How Much does a Medicaid Lawyer Cost?
Many senior citizens and their families are fearful that they cannot afford a Medicaid lawyer. However, an experienced Medicaid lawyer can save time, frustration, and substantial amounts of money over the long-term. In fact, having to forgo Medicaid nursing home coverage for even a single month can be more costly than hiring legal counsel.
At our firm, we provide affordable, cost-effective Medicaid planning. Once we know more about your personal situation, we can explain the matters that may need to be undertaken for your case.
How Long Does It Take to Get Medicaid in Florida?
The length of time it takes to receive Medicaid depends upon the type of benefit needed. For instance, individuals applying for family-related Medicaid through the Florida Department of Children and Families (“DCF”) usually receive a determination within thirty days (once eligibility has been verified), while someone needing long-term care may have to wait months, or even years.
What Types of Assistance Does Medicaid Provide for Seniors?
Medicaid’s Institutional Care Program (“ICP”) covers seniors who need nursing home care. While the application for benefits is also submitted through the DCF, applicants are required to exhaust other benefit resources, provide documentation regarding other medical coverage, and demonstrate financial need. When making an ICP determination, the DCF considers an applicant’s assets, income, prior transfers to family and friends, home value, debts, other insurance coverage, and family need. Due to the extensive evidence reviewed, ICP determinations can take months, especially if any issue arises.
For Seniors seeking home and community-based services through the Statewide Medicaid Managed Care (“SMMC”) and Long-Term Care Managed Care Program (“LTC”), the process can take years. Seniors must enroll in a list and wait until the government gives priority to their claim; seniors with critical conditions are given primacy. However, the waitlist can be bypassed if an individual is in a nursing home for sixty days.
Depending on the benefit sought, the Medicaid application process can be difficult and time consuming, necessitating the need for a skilled Medicaid planning attorney that understands how to potentially speed up the process. At the Flammia Elder Law Firm, we can review your case and help prepare a Medicaid plan that addresses your health care need as expeditiously as possible.
Can I Qualify for Medicaid After I’m in a Nursing Home?
Even if you are already living in a nursing home, you can still qualify for Medicaid. While your benefits may be less than if you had engaged in Medicaid planning prior to moving into a nursing home, nonetheless it is still usually beneficial to take actions that may result in Medicaid assistance.
Over two-thirds of all Florida nursing home residents pay for their care through Medicaid.[7] If a Floridian is already in a nursing home, the nursing home has a designated Medicaid bed available, and the individual meets the financial and health eligibility requirements, the applicant can receive Medicaid to help cover care expenses.[8]
We invite you to call us to learn how effective Medicaid planning may be beneficial to you.
[1] As we are a Florida elder law firm, this article is focused solely on the needs of seniors seeking Medicaid benefits. It is also important to note that the information contained herein (particularly including amounts noted for benefits, exemptions, and other matters) are subject to change. As a result, this information should be considered as general information only, and nothing contained in our website should be relied upon as legal advice. Because the circumstances of every individual will differ, if you desire legal advice for your situation, please call our firm to schedule an appointment.
[2] Access Florida, Florida Department of Children and Families, https://www.myflfamilies.com/service-programs/access/medicaid.shtml
[3] How Much Care Will You Need?, LONGTERMCARE.GOV, https://longtermcare.acl.gov/the-basics/how-much-care-will-you-need.html
[4] Eligibility, Medicaid.gov, https://www.medicaid.gov/medicaid/eligibility/index.html.
[5] Cost of Care Survey 2019, Genworth, https://www.genworth.com/aging-and-you/finances/cost-of-care.html
[6] Cost of Care Survey 2019, Genworth, https://www.genworth.com/aging-and-you/finances/cost-of-care.html.
[7] Medicaid in Florida, Kaiser Family Foundation, files.kff.org/attachment/fact-sheet-medicaid-state-FL.
