Florida Medicaid Long Term Care Eligibility
Florida Long Term CareFlorida is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application. As of 2014, Florida implemented a new system for long term care services through Medicaid. The program is called the Statewide Medicaid Managed Care Long-Term Care Program. Click the link for the most up-to-date changes. Request Information
Medicaid for Aged and Disabled (MEDS-AD)
- The MEDS-AD Program entitles eligible aged or disabled individuals to receive full Medicaid coverage.
- This program does NOT cover blind individuals unless they are considered disabled.
- Individuals cannot receive Medicare Part A or B unless the individual receives ICP, Hospice, or Home and Community Based Services (HCBS) Waiver.
Institutional Care Program (ICP)
- The Institutional Care Program (ICP) helps people in nursing facilities pay for the cost of their care and provides general medical coverage.
- Must need of nursing facility services and appropriate placement as determined by the Department of Elder Affairs (DOEA), must meet requirements as defined by the Comprehensive Assessment and Review for Long-Term Care Services (CARES).
Eligibility:1. Residency and Citizenship – the applicant must be a resident of Florida and a U.S. citizen or have proper immigration status. 2. Age/Disability – the applicant must be age 65 or older or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days. 3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 300% the Federal Benefit Level ($2,250) to become eligible for Medicaid. Persons with income in excess of $2,250 can still qualify for Medicaid coverage if excess income is placed into a Qualifying Income Trust (QIT). The trust must be irrevocable and Florida must be the designated recipient when the beneficiary dies. Only income in excess of $2,250 must be placed in the trust.
- A personal needs allowance of $105/month is not factored into the total countable income.
- Florida is an “income first” state, which is described above, but also means the state can limit the right to petition for an increased community spouse resource amount (CSRA). Basically, this means a community spouse must petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first. Increased income will not automatically be granted.
Exempt Assets for an applicant in Florida include:i. $2,000 or less in cash/non-exempt assets if single. If married and both spouses require nursing level care the resource limit is raised to $3,000. ii. One home is exempt (equity limit $572,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum. iii. One automobile, no equity amount specified. iv. Irrevocable burial trust, no amount specified. v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
Spousal Rules:Amount of assets community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $123,600.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,030. The maximum amount of income that can be retained is $3,090 varying by case, depending on unique living expenses.