Medicaid Planning for Institutional Care Program Benefits

Elder Law advises clients regarding how to obtain public benefits, including Medicaid. The Medicaid Institutional Care Program (ICP) is a federal/state program that pays most nursing home costs for people who meet three eligibility requirements, including being aged or disabled, having a medical need, and a financial need. In Florida, eligibility for Medicaid is determined by the local county Department of Children and Families, Office of Economic Self Sufficiency, and is administered at the state level by the Agency for Health Care Administration.

In determining the financial need of a Medicaid applicant, Florida’s financial criteria is based on the “income cap” and the “asset test.” There are certain assets that are exempt from consideration and can be kept when applying for Medicaid. These include:

• Personal residence ($603,000 maximum equity value)
• Automobile
• Whole life insurance with a cash surrender value of less than $2,500
• Prepaid funeral plans
• Household furnishings

Planning ahead by consulting with an elder law attorney early will help preserve assets should placement in a skilled nursing facility become necessary. However, even when advance planning has not been done, an elder law attorney can still help preserve assets and avoid very costly mistakes.

In Florida, in order to be eligible for Medicaid ICP, an individual must be determined to be medically needy by the Department of Children and Families (DCF) and must be residing in a Medicaid qualifying nursing home or an Assisted Living Facility (which participates in the Medicaid Waiver Program). Additionally, an individual who is applying for Medicaid must have an income of $2,382 or less per month as of January 1, 2021 ($2,349 per month was the standard between July 1, 2020-December 31, 2020) and assets of less than $2,000. If the individual has a spouse who is not currently living in a nursing home, the so-called “community” spouse’s maximum income allowance is $3,260. If the other spouse is also living in a nursing home, the other spouse is only permitted to have an income of $2,382 per month.

Medicaid Applications

The attorneys at Elder Law are knowledgeable and experienced in filing and gaining approval of all types of Medicaid applications. We initiate the two-step filing process with an online application, maintain excellent working relationships with caseworkers, perform all follow-up work and keep abreast of agency and statutory modifications and rulemaking.

We are integrally involved in the Elder Law Sections of the Florida Bar and New York Bar, the Academy of Florida Elder Law Attorneys, the New York Chapter of NAELA, and the National Academy of Elder Law Attorneys, and thus participate in the implementation of new laws, like the Deficit Reduction Act of 2005 (DRA). We are constantly interpreting the program and policy manuals that contain nuanced information about the application process. Furthermore, we work together with area facilities to achieve results for both our clients and the facilities.

A married couple living in a nursing home is only permitted to have $3,000 in assets. If an individual is living in a nursing home and has a spouse living in the community (not living in a nursing home), the individual residing in the nursing home is allowed to have $2,000 in assets and the spouse living in the community is permitted to have no more than $130,380 (up from $128,640 in 2020) in assets. However, if the community spouse has assets in excess of $130,380, a legal technique known as “spousal refusal” may be utilized to allow the community spouse to keep more than this amount. One residence (with an equity value not exceeding $603,000), one automobile, personal property, household furnishings, pre-need funeral and burial arrangements, and a burial account of $2,500 are all exempt assets and are excluded from the asset limitations.

Under the Deficit Reduction Act of 2005 (DRA), if an individual transfers assets during the five years prior to applying for Medicaid, an ineligibility period will be assessed wherein Medicaid benefits will be denied. Post-DRA, the ineligibility period will not commence until the individual would be otherwise eligible for Medicaid as specified by the criteria above. Caution should be taken, and a full analysis should be done by an elder law and special needs law attorney before any transfers are made. If prior transfers have been made, there are strategies that can address those prior transfers thus still allowing a person to qualify for Medicaid. Caution should be taken, and a full analysis should be done by an elder law attorney before any transfers are made.

Elder Law provides Medicaid Planning services to clients throughout Florida. For more information or to make an appointment with one of our experienced elder law attorneys, contact us today. At Elder Law, we give families peace of mind.

Home & Community-Based Medicaid Waiver Services, Assisted Living Facilities, and Home Care Aides

Many Florida residents are unaware that Medicaid also covers assisted living facilities (ALFs) and even home care. Through a variety of programs that are administered through the Department of Elder Affairs (DOEA), the Department of Children and Families (DCF), and the Area Agency on Aging (AAA), residents may qualify for Medicaid funding even though they remain at home or in an ALF, and in many cases, need not enter a skilled nursing facility.

Elder Law represents the best interests of our clients who most often would prefer to remain at home with assistance or in the more social environment of an ALF. Therefore, we are well-versed in these programs and discuss them as an integral part of our planning process.

Clients should be aware that home and community-based programs and services are often subject to a lengthy waitlist process. Therefore, the sooner a person’s name is placed onto the applicable waitlist, the sooner Medicaid benefits in the home or at an ALF can be obtained.

Long-Term Care Planning

Elder Law utilizes various legal techniques and legal instruments which protect and preserve assets for our clients. We advise our clients regarding the most appropriate long-term living arrangements for their particular situation and assist with facility placement.

Our firm develops personalized plans for clients and their families as loved ones age, including the best use and management of personal and financial resources to meet their long-term objectives, exploring all home-based care options as a first priority when appropriate and easing transitions in the event a facility placement is required.

Planning ahead by consulting with an elder law and special needs attorney early will help preserve assets should placement in a skilled nursing facility become necessary. However, even when advance planning has not been done, an elder law and special needs attorney can still help preserve assets and avoid very costly mistakes.

We provide long-term care planning services to clients throughout New York and Florida, particularly in the following cities/municipalities and surrounding communities in South Florida near our offices:

• Palm Beach County: Boca Raton, Delray Beach, Boynton Beach, Highland Beach, Lake Worth, West Palm Beach, North Palm Beach, Palm Beach, Royal Palm Beach
• Broward County: Coconut Creek, Deerfield Beach, Fort Lauderdale, Hollywood, Margate, Plantation, Pompano Beach, Sunrise, Tamarac, Weston
• Miami-Dade County: Aventura, North Miami, North Miami Beach, Sunny Isles, Miami Shores

Long-Term Care Insurance

Elder Law advises and assists clients in planning for and purchasing long-term care insurance, a vital asset preservation tool. Long-term care insurance can reduce the financial risk of long-term disability and provide financial security for loved ones.

We have established relationships with some of South Florida’s most widely known insurance agents and companies and are able to pass along this resource to the benefit of our clients. We also can work with the client and his or her insurance agent in making critical decisions regarding the type and extent of coverage to purchase.

We also assist our clients who already have long-term care insurance policies in place in filing claims. The claims process for long-term care can be daunting for many people and is fraught with traps for the unwary. We offer our clients peace of mind by helping them to navigate this difficult and challenging process.

For more information or to make an appointment with one of our experienced elder law attorneys, contact us today. At Elder Law, we give families peace of mind.