Nursing facilities such as skilled nursing facilities, assisted living communities, and adult facility care homes, provide various levels of supervision and support to their residents. For people who cannot live by themselves, these places offer semi-private or private accommodations. For loved ones who are elderly or disabled, an assisted living can offer a sense of independence while also ensuring medical needs are supported. One of the biggest issues when it comes to assisted living is funding. These facilities are often paid for through existing assets, income, long-term care coverage, and benefits from programs such as Medicaid. Here’s what long-term care expert Antony Turbeville wants you to know about qualifying for benefits. 

Qualifying for Medicaid in Florida

Medicaid is a federal and state program designed to help cover healthcare expenses for those who have limited income and financial resources. There are several technical criteria applicants must meet to qualify in the Sunshine State:

• You must be a U.S. citizen or a qualified, legal non-citizen.
• You must be a resident of Florida. Being admitted to a nursing home qualifies you as a resident.
• You must have or have applied for a social security number.
• You must provide ID unless you’re receiving Medicare or supplemental security benefits.
• You must apply for any other benefits for which you’re eligible, including pensions, disability, retirement, etc.
• You must also notify Medicaid of any other third parties that are liable for paying for nursing home care, such as an insurer.

Beyond these technical requirements, there are other needs-based criteria that must be met.

Meeting Need-Based Criteria

Similar to Medicare, Medicaid also has criteria related to need. Unlike Medicare which covers skilled care, Medicaid can also cover skilled and custodial care. This allows applicants with impairments that impact their ability to perform daily living activities to be eligible for Medicaid. Considerations for medical needs include the following:

• The need for 24-hour care in a non-hospital facility that has doctors, nurses, and other medical staff
• The extent of medical supervision required
• The length of observation required

To qualify for Medicaid, an applicant must meet an age and/or disability requirement. Applicants must either have a disability (as per Social Security of the Florida Disability Medical Review Team), be at least 65 years old, or be blind.

Understanding Financial Need Requirements

Antony Turbeville would point out here that the financial aspect of Medicaid eligibility is one that tends to disqualify many applicants. There are two tests used to determine financial need with Medicaid:

• Asset test: What assets do you have, including savings, real estate, valuables, etc?
• Income test: How much money do you make, including earned income and other income sources?

You might expect that having a certain amount of assets and income would remove your ability to qualify for Medicaid. While this is true, many applicants make the mistake of getting rid of assets in order to qualify. Mr. Turbeville recommends working with a Medicaid application service and attorney as early as possible. This service collects all the necessary information so that you and an attorney and professionals can come up with a plan. Working with an application service and a pro helps you qualify for Medicaid without needlessly getting rid of assets and income.  Many assets can be recategorized or exchanged for other assets.  Doing so keeps the asset value in the applicant’s name without disqualifying the applicant for benefits.  Importantly, done correctly such transactions can keep liquidity in the family.

Tony can be reached at 1-800-582-1934.