At some point during your retirement years, there is a good chance that you, or your spouse, will need long-term care (LTC). You will find that the cost of that care is high. Nationwide, the average cost of a year in LTC was around $80,000 in 2016. In the State of Florida, you can expect to pay a bit more than the national average, with the average cost running around $90,000 for a year in LTC in 2016. Given the high cost of LTC, it is not surprising that over half of all seniors needing LTC turn to Medicaid for help covering the cost. At the Kulas Law Group, we understand how difficult it can be to navigate the Medicaid program. With that in mind, we put together some frequently asked questions and answers about Medicaid and related elder law issues that you may find helpful. If you have additional questions, please feel free to contact our office to schedule an appointment for a consultation.
1. Won’t Medicare cover my LTC expenses?
Unfortunately, no. Medicare only covers LTC expenses in very limited circumstances and only for a very short period of time. Consequently, you cannot depend on help from Medicare with your LTC bills nor should you rely on your basic health insurance plan, if you have one. Most health insurance policies exclude LTC expenses unless you purchased a separate LTC plan and paid an additional premium.
2. Will I be eligible for Medicaid?
In order to know for sure, you will need to apply; however, knowing the basic eligibility requirements ahead of time helps. To qualify for Medicaid to help cover nursing home expenses in Florida, you are generally required to be a U.S. citizen; however, there are several other status categories that are also potentially eligible for Medicaid. You must be in need of the type of care that only a nursing home can provide and you must meet the income limit requirement. The income limit changes each year and is tied to the Federal Poverty Level for your area and household size. The biggest obstacle to Medicaid eligibility for seniors who failed to plan ahead is the “countable resources” limit. To qualify for Medicaid, you may not have countable resources, or non-exempt assets, valued at over $2,000.
3. How do I apply for Medicaid?
Applying for Medicaid is fairly easy in Florida as it is done online through the ACCESS Florida website. You should have basic information (Social Security numbers, monthly income, etc.) handy when you sit down to apply. You can also request a paper application, or some hospitals and other healthcare facilities have a Medicaid coordinator that can help you apply.
4. What happens if my resources exceed the limit for Medicaid?
If the value of your non-exempt assets exceeds the resource limit when you initially apply for Medicaid, you will not qualify and you will be expected to pay for your LTC out of your own pocket. Transferring assets in contemplation of applying for Medicaid won’t work because Medicaid uses a five-year “look-back” period. The look-back rule allows Medicaid to review your finances for the five-year period prior to application for any assets transfers made for less than fair market value. If uncompensated transfers were made, Medicaid will withhold coverage from you. The way to avoid finding yourself in this situation is to incorporate Medicaid planning into your estate plan long before you are likely to need to qualify for Medicaid.
5. How do I pick the right nursing home for my spouse/parent/loved one?
You have likely heard at least one nursing home abuse horror story, making you very leery of putting a loved one in nursing home care. While nursing home abuse and neglect does occur, the good news is that there are also a number of nursing homes that provide skilled and compassionate care. You may wish to begin your search by asking friends, family members, and co-workers for a referral. Once you have a list of possible facilities or providers, do some research. Check for complaints with the Florida Agency for Healthcare Administration. Also, make a point of showing up unannounced to see how the facility operates when they are not expecting you.
6. What are some common signs of elder abuse?
In order to protect your elderly loved one, you must remain vigilant even after choosing a facility or caretaker. Specifically, you must remain on the look-out for any sign of elder abuse or neglect which may include:
- Excessive and/or unexplained injuries
- Bruises or marks on wrists and/or ankles from restraints
- Weight loss
- Mood swings
- Deteriorating hygiene
- Depression or anger
- Unpaid bills without explanation
- Money/items missing
7. What should I do if I suspect that a loved one is the victim of elder abuse?
If you suspect that a loved one is the victim of elder abuse and/or neglect, do not hesitate to act on your suspicions. Typically, if you feel something is wrong, it probably is. Try talking to your loved one. Unfortunately, may elderly victims do not speak out when they are victimized either because they are embarrassed to be a victim or because they fear reprisals for doing so. Speak to the administrator of the facility as soon as you become concerned. If your suspicions are confirmed, contact law enforcement authorities and make a report.
For more information, or if you have specific questions or concerns regarding elder law or Medicaid in Florida, contact the experienced Florida elder law attorneys at Kulas Law Group by calling (772) 398-0720 to schedule an appointment.