That’s a question that many Florida seniors eventually find themselves asking, and it’s an important one. The fact is that nursing home costs have skyrocketed in recent decades, and the average senior can be placed in a perilous position when nursing home care is necessary but he or she lack the means to pay for that care. Without Medicaid, many of the state’s seniors would be left without any ability to receive the vital health and daily living assistance they need to enjoy the care and dignity they deserve. So, how can you know whether you can qualify for those critical Medicaid benefits?
There are two specific criteria that must be met before you can be considered eligible for Medicaid for nursing home care. The first involves an actual need for that level of care. Obviously, the entire system has an interest in not paying for nursing home care that is not actually necessary. As a general rule, that is the easier of the two requirements to meet. The second eligibility requirement involves meeting certain asset and income limits. It is that eligibility requirement that often poses the most difficulty for Florida seniors.
Medicaid Eligibility: Health Care Needs
Before you can qualify for Medicaid payment for your nursing home costs, the program has to determine that you need that type of care. To do that, someone from Comprehensive Assessment and Review for Long-Term Care Services (CARES) has to conduct an interview with you to determine that you have a medical condition that warrants being in a facility with readily available medical care. That assessment involves a series of questions designed to see how well you can manage without such care.
Basically, the assessment results need to find that you have a medical need for the care you’re asking Medicaid to pay for. That means that the nursing home care must be necessary for pain control, the prevention of even more serious conditions, or the protection of your life. That care also has to be determined to be appropriate for the symptoms that are being treated as judged in accordance with accepted standards, and there can’t be any less costly alternatives available.
Medicaid Eligibility: Income and Assets
For seniors who definitely need ongoing nursing care, that first qualifying requirement may be the easy part. Seniors must also meet strict asset and income standards. They are as follows:
- You cannot have income that exceeds $2,199 per month. There are ways around this, however, if you establish an Irrevocable Qualified Income Trust, or QIT.
- There is no income requirement for your community spouse, since his or her income doesn’t get counted when the program determines your eligibility.
- That income includes basically all of the money made available to you through Social Security, disability, VA benefits, pensions, annuities, IRA distributions, dividends, and so on.
- If your spouse’s income is below a certain level, he or she may be entitled to a portion of your income to meet the minimum standards. Your community spouse is entitled to receive as much of your income as is necessary to increase his or her own income to the minimum standard of $1,991 per month. In some instances, a showing of greater need can allow your spouse to keep even more of your joint income.
- Where assets are concerned, you are entitled to have no more than $2,000 in countable assets. Your spouse is allowed to keep assets up to a level of $119,220.
- In addition, certain assets are excluded from consideration. For example, you are allowed to keep your home as long as the equity is no more than $552,000.
- Other excluded assets include one vehicle. A second may be exempt from consideration provided that it is at least seven years old. Furniture and other household items are generally not counted either.
- You’re also entitled to a properly structured retirement account, burial fund, and rental properties – though any income generated from your assets may be subject to the income test.
Cutting Through the Confusion with Sound Planning
For seniors in Florida who are trying to qualify for Medicaid, there are many challenges. For some, the strict eligibility requirements can make it difficult to qualify without spending all of their assets first. Many seniors are understandably reluctant to make themselves that dependent upon any government program, but these seniors also know that they cannot afford the more than $8,000 it can cost each month to live in a nursing home.
The good news is that there are options that can help ensure that you qualify for this important program, even when your assets and income might exceed those limits. While it is always best to begin planning for Medicaid years in advance of any actual need for care, it is almost never too late to take steps to protect assets and preserve some portion of them for your own use or as a legacy for your loved ones when you pass away. Effective Medicaid planning offers a solution that can accomplish those goals for your estate.
At Robert Kulas Attorneys at Law, we can help you to determine whether you’re eligible for Medicaid assistance. Our Medicaid planning professionals can also work with you to ensure that you protect as many assets as possible through the use of effective estate planning tools and strategies that have a proven track record of success. Moreover, our strategic guidance can help you to avoid many of the most common errors seniors make when they try to qualify for benefits on their own – like errant gifting that causes them to run afoul of Medicaid’s five-year look-back eligibility penalties. With our help, you can rest assured that you’ll get the funding you deserve and enjoy the nursing home care you need. To find out more about how we can assist you with your Medicaid planning efforts, contact us online or call us today at (772) 398-0720.
