Florida Medicaid Q & A
Q: Must all of an institutionalized person’s income be paid to a nursing home for their care?
A: Not all Medicaid will deduct any monthly health insurance premiums and the $35 for personal need allowance. A spouse or other qualifying dependent will also be allocated a monthly allowance based on their income and shelter expenses. The rest of the institutionalized person’s income will be paid to the nursing home.
Q: Will I have to use my income to help pay for my spouse’s nursing home care who is Medicaid qualified?
A: No. If your spouse is Medicaid qualified, only his/her income will be used to pay for nursing home care minus allowable deduction discussed above.
Q: If my income is above Medicaid’s income guidelines, will I be required to help pay for the nursing care facility for my spouse?
A: No. The income of the spouse living at home is not considered. You will not need to use your income to pay for your spouse’s nursing home care.
Q: What is considered income?
A: Any income such as pensions, alimony, Social Security, rental property, VA benefits, annuity pay outs, and IRA distributions is considered.
Q: My disabled child lives with me. If I go into a nursing facility will he/she be able to keep my income for his or her support?
A: When there is a disabled child there are guidelines that will allow him or her to receive part or all of your income.
Q: As a single person if I go into a nursing home can my income be used to pay for my home expenses?
A: If you qualify for Medicaid and you are single, your entire income minus the allowable deductions discussed above must be paid for nursing home care.
Q: Does Medicaid follow the same rules as the IRS in regards to assets?
A: No. Medicaid has its own set of rules. It does not follow the same rules as the IRS.
Q: What are considered assets?
A: Assets are anything of value such as real estate, vehicles, financial accounts, life insurance policies, and some trusts. An IRA with the monthly RMD (required minimum distribution) set up will not count as an asset.
Q: My father and I have a joint bank account. Can I take half of the money before he applies for Medicaid.
A: Only if you can prove that you contributed to half of the money that is in the account. Otherwise, no. Without documentation for your contributions, Medicaid will view all joint bank accounts and investments to be hers.
Q: I have a disabled child. Can I give any of my assets to him or her?
A: Yes. According to Medicaid the assets can be transferred to the disabled child of any age. Proof of social security must be provided.
Q: Is my winter home in another state considered a countable asset?
A: Yes. All real estate is considered in determining assets. However, there are allowable exceptions.
Q: Will Medicaid take my house that is homesteaded?
A: No. Your primary home is protected in Florida from all creditors including Medicaid. However, depending on the amount of equity in the home, an individual may be ineligible. Otherwise the home in exempt as an asset.
Q: My mother has a second home that is rented. Will the home count as an available asset if she should go into a nursing home?
A: No. As long as it is rented for fair market value, the rental property is excluded as an asset. However, the income minus expenses will go to the nursing home to help pay your mother’s patient responsibility.
Q: Is the cash value of my life insurance policy considered a countable asset or is that exempt?
A: Medicaid only allows for a $2,500 face value exemption. The cash values of life insurance policies with a face value over $2,500 is considered a countable asset
Q: Are the limitation on purchasing a pre-need burial planning?
A: There are no limitations if the burial contract is irrevocable. For contracts that are revocable, Medicaid allows for $2,500 burial contract that is not viewed as an asset.
Transfers & Gifts
Q: What is the look back period?
A: Medicaid will require information to be provided for all assets given away within the past five years.
Q: Am I allowed to give my two children every year the allowable $14,000 tax exemption?
A: No. That is an IRS guideline, not Medicaid. Medicaid has no such allowable transfer.
Q: What if I already gave money to my children and now need nursing home care?
A: All transfers and gifts need to be disclosed to the Department of Children and Family Services. Senior Information Centers will work with elder law attorneys to explain your options.
Q: My husband just entered a nursing home. Will I be required to provide bank statements dating back five years?
A: No. Typically you will need to provide statements for the past three months. Medicaid has the ability to look into 5 years of bank statements.
Q: I have been living with my son/daughter and contributing to household living expenses or rent. Is this money considered a transfer?
A: Not if the amount you paid is considered fair and reasonable. If so, it will be considered normal living expenses.
Q: If I am penalized for recent transfers and gifts, what will Medicaid do?
A: Medicaid has a calculation to determine the penalty period, using the current division of $7,362.
EXAMPLE: Assuming Jane otherwise qualifies for Medicaid and she transfers $30,000 in November 2008 and $20,000 in December 2008 for a total transfer of $50,000, her penalty period is 6.8 months. This is calculated by dividing $50,000 by $7,362. Jane cannot apply for Medicaid due to the fact that she has created a 6.8 month penalty from the date she applied for Medicaid.
Long-term care is funded by three different ways:
Individual or family members pay for the cost of the nursing care or assisted living facility.
Long-term care insurance
If you have assets worth protecting, are young and healthy enough to qualify, and can afford the premiums, long term care insurance may be your best option.
Achieving Medicaid qualification can be a daunting task. An elder law attorney specializing in Medicaid issues can assist an individual with decisions and help avoid costly mistakes.
When there is a married couple, the spouse in the nursing home is called the Institutionalized Spouse and the spouse staying at home is called the Community Spouse.
Qualifying for the Florida Medicaid Institutional Care Program (ICP)
The Medicaid program in Florida is now called the SMMC-LTC (Statewide Medicaid Managed Care).
Long-Term care program:
This program provided Medicaid assistance to all qualified individual from 18 years of age and older whether they reside in a nursing home, assisted living facilities or at home.