MEDICARE

Medicare home health information can be found here: https://www.medicare.gov/coverage/home-health-services.html

Upon discharge from a hospital or rehab facility a CHAA agency (Certified Home Health Aide agency) will be assigned and paid for by Medicare. The CHAA will provide an aide, PT, OT and Social Work services. The amount of services is determined by the CHHA agency. Typically, a bath aide will be provided who will come a few hours a day.

Florida Medicaid (SMMC-LTC) Income & Assets Limits for Nursing Homes & Long Term Care

May, 2018

Medicaid is a wide-ranging, federal, health care program for low-income individuals of any age. However, this page is specifically focused on Medicaid eligibility for Florida residents who are 65 years of age and older. The focus will also be on long term care, whether that be at home, in a nursing home or in assisted living. Make note, Medicaid in Florida is sometimes referred to as the Statewide Medicaid Managed Care (SMMC) program. The Medicaid managed care program for long-term care services for the elderly and disabled is called the Long-term Care (LTC) program. All other health care services outside of long-term care are provided via the Managed Medical Assistance (MMA) program.

Income & Asset Limits for Florida Eligibility

There are several different Medicaid long-term care programs for which Florida seniors may be eligible. These programs have slightly different eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Florida offers multiple pathways towards eligibility.

1) Institutional / Nursing Home Medicaid – is an entitlement (anyone who is eligible will receive assistance) & is provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services – Limited number of participants. Provided at home, adult day care or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement and is provided at home or adult day care.

Eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Florida offers multiple pathways towards eligibility.  The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from a Florida Medicaid program. Alternatively, take the Medicaid Eligibility Test.  IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.

What Defines “Income”

For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. (As of 2018, this figure falls between $2,030 / month and $3,090 / month). This rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.

What Defines “Assets”

Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $123,600 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).

One should be aware that Florida has a Medicaid Look-Back Period, which is a period of 60 months that dates back from one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of Medicaid ineligibility will ensue.

Qualifying When Over the Limits

For Florida residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – In a nutshell, one may still be eligible for Medicaid services even if they are over the income limit if they have high enough medical bills, which includes health insurance costs, such as Medicare premiums, as well as bills to cover medical services. The way the Medically Needy Program, also sometimes referred to as a “Share of Cost” Program or a “Spend-Down” Program, works is one’s “excess income,” (their income over the Medicaid eligibility limit, which is often referred to as one’s “share of cost”), is used to pay their medical bills. Once one has paid down their excess income to the Medicaid eligibility limit, Medicaid will kick in for the month. This program, regardless of name, provides a means to “spend down” one’s extra income in order to qualify for Medicaid.

Make note, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. It’s important to note, one cannot simply give away assets or sell them for significantly less than their value, as Florida has a 5-year Medicaid Look-Back Period that prevents applicants from doing so. If one is found in violation of the look-back period, this may result in a period of ineligibility.

2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care.  For persons in this situation, Medicaidplanning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.

Specific Florida Medicaid Programs

Like many states, Florida has been replaced their Medicaid HCBS Waivers with a Medicaid managed care program. Former waivers such as the Alzheimer’s Disease Waiver, Nursing Home Diversion Waiver, Assisted Living for the Elderly (ALE) Waiver and the Consumer Directed Care Plus (CDC+) Waiver have all been discontinued and replaced with the Statewide Medicaid Managed Care – Long Term Care (SMMC-LTC) program. To be clear, most but not all of the services and benefits that were available under the older waiver system have been preserved with the new Medicaidmanaged care model.

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Required documentation:

Social security card
Medicare card
Birth Certificate (Proof of Citizenship)
Naturalization papers
Marriage Certificate
Spouse’s Death Certificate
Separation/Divorce Papers
Military Discharge Papers
Health Insurance Card, Premium and Proof of payment
Current lease, deed, mortgage payment (Any proof of rent or real estate)
Current utility bill in applicant name
2 Letters of residency (Not a relative or landlord – include address and relationship)
Life Insurance Policies
Burial Arrangements
Copy of net and gross income (Social security letter, pension, pay stub)
Income tax returns/1099’s & W-2’s (Last five years)
All bank account statements for the past 60 months (open and closed – all pages) – Explanation of all transactions over $2000
Stocks and Bonds, IRA’s, Annuity’s etc.
Power of Attorney