Elder Law and Medicaid Frequently Asked Questions

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.

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.

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.

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.

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.

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

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.