Most seniors count on Medicare to cover their healthcare expenses during their retirement years. While Medicare does help with most healthcare expenses, it doesn’t cover everything. One of the most important exclusions from Medicare coverage is long-term care. For seniors, this exclusion can come as a surprise – and can lead to the depletion of their retirement nest egg should long-term care (LTC) actually be needed. Fortunately, the Medicaid program may be able to help; however, you must first qualify for benefits. Navigating the various Medicaid programs and corresponding eligibility criteria can be a daunting task. The Florida Medicaid lawyers at Kulas & Crawford explain some of the more common Medicaid programs for seniors and the eligibility requirements for those programs.
What Is Medicaid?
Medicaid is a healthcare program for low-income individuals and families that is primarily funded by the U.S. federal government, though the individual states can supplement funding and administer the program. Because Medicaid is administered at the state level the eligibility requirements and programs offered will vary from state to state.
Florida Medicaid for the Aged and Disabled
Florida residents who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid coverage from the Social Security Administration. There is no need to file a separate ACCESS Florida Application unless nursing home services are needed.
Medicaid programs for seniors fall into one of two categories – full benefits and partial benefits. Medicaid programs that have full benefits include:
- Medicaid for aged and disabled individuals (MEDS-AD)
- Institutional Care Program (ICP)
- Home and Community Based Services (HCBS) Waiver Programs
Medicaid programs that have limited benefits include:
- Medically Needy (MN)
- Medicare cost-sharing programs:
- Qualified Medicare Beneficiary (QMB)
- Special Low-income Medicare Beneficiary (SLMB)
- Qualifying Individuals 1 (QI-1)
To qualify for any of the Medicaid programs for the aged or disabled you must meet the following general requirements:
- Aged, Blind or Disabled – an individual must be aged (65 or older) or, if under age 65, blind or disabled. Note: The disability must prevent the individual from working and be expected to last for a period no less than 12 months, or be expected to result in death. Individuals who receive a disability check from the Social Security Administration (SSA) based on their own disability automatically meet this requirement. A disability determination is completed by SSA or the state Division of Disability Determinations (DDD). DCF submits requests to DDD after the Medicaid application is received.
- Citizenship Status – an individual must be a U.S. citizen or a qualified non-citizen. Note: There may be a waiting period for non-citizens admitted to the U.S. with a qualified status on or after August 22, 1996.
- Identity – an individual must provide proof of identity. Exceptions: individuals receiving SSI, Medicare or Social Security Disability based on their own work history.
- Residency – an individual must be a Florida resident.
- Social Security Number – an individual must have a social security number or apply for one.
- File for Other Benefits – an individual must apply for other benefits for which they may be eligible (i.e. – pensions, retirement, disability benefits, etc.).
In addition to the general eligibility requirements, each Medicaid program also has income and asset limits that an applicant cannot exceed. The limits depend on the program. For SSI based Medicaid, an individual cannot have more than $750 a month in income nor non-exempt assets that exceed $2,000 for 2018. For the MEDS-AD program, an individual may have income up to $891 and assets cannot exceed $5,000. Information on the income and asset limits for all Medicaid programs for seniors can be found on the Financial Eligibility Standards Factsheet for 2018.
The Importance of Medicaid Planning
All Medicaid programs have asset limits. Although some assets are exempt, most seniors find that the value of their non-exempt assets exceeds the program limit if they failed to plan ahead. The key to ensuring that you will be eligible for Medicaid if the time comes that you need it to help cover LTC expenses is by including Medicaid planning in your overall estate plan.
Contact Florida Medicaid Lawyers
For more information, please join us for an upcoming FREE seminar. If you have additional questions or concerns regarding Florida Medicaid eligibility or Medicaid planning, contact the experienced Florida Medicaid lawyers at Kulas & Crawford by calling (772) 398-0720 to schedule an appointment.