Medicaid in the United States is a federal and state program that helps with healthcare costs for people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. The Medicaid program covers 1 in 5 Americans, including many with complex and costly needs for care. The program is the principal source of long-term care coverage for many Americans. Florida Medicaid is the state and Federal partnership that provides health coverage for selected categories of people in Florida with low incomes.
The difference between Medicaid and Medicare is that Medicaid is managed by states and is based on income. Medicare is managed by the federal government and is mainly based on age. There are, however, special circumstances, like certain disabilities, that may allow younger people to get Medicare.
To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of healthcare insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:
- Pregnant, or
- Be responsible for a child 18 years of age or younger, or
- Blind, or
- Have a disability or a family member in your household with a disability, or
- Be 65 years of age or older.
To be eligible, a person must have an annual household income (before taxes) that is below a designated amount.
Medicaid is used to pay for medical care. Long-term care costs can be overwhelming to Florida families. Florida Medicaid Planning can assist with legally and ethically shifting assets from “unprotected” to “protected” so an individual may qualify for Medicaid benefits. This can greatly help a family with long-term care costs and keep assets with the spouse. One aspect of this process is known as Medicaid Spend Down.Â
In general, an individual can use Medicaid Spend Down, which consist of a series of financial strategies when a person’s assets are too high to qualify for Medicaid. An individual must spend down some of these countable resources to reduce the level downward to qualify for Medicaid.
Various states have different asset thresholds. Consequently, an individual would have to spend down eligible assets to receive benefits. In Florida, the current threshold is a $2,000.00  asset limit and $2,382.00 monthly income limit. Countable assets to determine a spend down potential could include savings accounts, IRAs, and 401(k)s, and other investments including stocks, bonds, and mutual funds. In other circumstances, certain categories of funds are deemed exempt or non-countable. However, in order to do a spend down can depend on a variety of factors. To determine how to calculate the spend down amount while considering each individual financial situation, you should consider working with a Florida Medicaid Planning Attorney.
Many of the biggest public concerns include paying for prescriptions, expensive medical care, home health care (home health aides), ALF bills, and nursing home bills. For those who are disabled or over age 65, spending down permits a person the opportunity to receive mandatory benefits, which include services such as inpatient and outpatient hospital services, physician services, laboratory and x-ray services, and home health services, among others. An individual may also receive optional benefits, which include prescription drugs, case management, physical therapy, and occupational therapy.
A few reasons people will need to spend down their assets are receipt of a large sum of money that would put them over the allowable Florida Medicaid eligibility limits. The foregoing may occur due to receipt of a personal injury settlement, an inheritance, or any other large payout. Occasionally, if the increase in assets only puts the individual over the threshold by a few thousand dollars, the spend down could be as simple as paying off some debt, prepaying for funeral expenses, or making repairs to the house, etc. In the alternative, if a person is quite a bit over the limit, however, a Florida Medicaid Planning Attorney, such as those in the law firm of CASERTA & SPIRITI, should be consulted to make sure that the spend down is done appropriately and that money is not wasted. Â Accordingly, there are a variety of strategies using special needs or irrevocable trusts, Medicaid compliant annuities, personal service contracts, and certain other investments to name a few, which allow a Medicaid spend down plan to avoid waste and to periodically allow the set aside of funds to be used at a later date.
Florida is one of two states, which allow spousal refusal. Â In these scenarios, the well (or community or at home) spouse will refuse to provide support for the ill spouse who needs nursing home care. As a result, the spouse who needs care will immediately be eligible for Medicaid and receive services with these expensive facilities.
Further, when applying for Medicaid, a person or family must ensure that they have not given assets away within a specified period of time or look back period prior to applying for Medicaid; otherwise, it can result in a Medicaid transfer penalty. Again, a Florida Medicaid Planning Attorney, such as those in the law firm of CASERTA & SPIRITI, can provide appropriate counsel.