There are four main eligibility requirements for the Medicaid Institutional Care Program( nursing home Medicaid or Medicaid ICP) and Long Term Care Diversion Programs.
1. Income: In Florida, there is a Gross maximum income limit. For the year 2011 that limit is $2022.00. If a senior's income exceeds that amount, there is a work around which can be used. However, this “work around” can only be accomplished with the assistance of an attorney. The “Patient Liability or Responsibility” is the amount a senior or disabled person must contribute to their care. This amount is based on his/her monthly income. Once this monthly “deductible” is paid, Medicaid will pay the nursing home the remaining expense based on the approved rate for the facility. Additionally, Medicaid will pay all costs that Medicare does not cover such as premiums, deductibles and co-pays. For a senior or disabled person living in Florida, “Patient Responsibility” is the senior’s total gross income minus two amounts: 1) the cost for any monthly health premiums and 2) $35 as a personal expense allowance. For a married couple, calculating Patient Responsibility is a bit more complicated. Generally, if the well spouse (community spouse) has a modest income, the applicant is allowed to divert a portion of their income to assist their “well spouse” in maintaining a reasonable standard of living. This is called “Spousal Income Diversion”. The second Test is of Assets. The Asset Limit of $2,000 ($5,000 if applicant’s gross income is below $763 per month) is for a single individual. The community spouse may keep $109,560.00 of countable assets. There are also provisions for Adult Disabled Children. The third and final test is Medical. The Department of Elder Affairs must determine the individual “Medically” eligible for Medicaid.
2. 65 years of age or blind or disabled
3. U.S. citizen or qualified alien
4. Florida Resident.
Excluded Assets
- Homestead – If the spouse or certain dependent relatives continue to reside in the home, it is excluded. Also, if the applicant intends to return to the home, the home is excluded. The Deficit Reduction Act of 2005 may change this.
-
- Life Insurance – All term life, group term or death benefit only policies are excluded since they have no cash value. Policies that have cash value may be counted as assets. The total face value of all of cash value policies determines if the life insurance policies are counted as assets. If the total face value of all cash value policies is equal to or less than $2500, then any cash surrender values in the policies are not counted. If the total face value of all cash value policies exceeds $2500, the total sum of the cash surrender values of all policies is counted as an asset. Since this matter can be confusing, it’s often best to consult with a Medicaid Counselor to determine if a senior’s cash value life insurance policies are countable assets or excluded.
-
- Burial Funds and Prepaid Funeral Contracts – The full value of an irrevocable burial or cremation contracts are excluded regardless of the amount.
-
- Burial Savings Accounts – Medicaid allows a $2500 exclusion for funds that have been designated for burial expenses.
-
- Personal/Household Goods – Personal items in the home such as home furnishings are excluded assets.
-
- IRAs – are not counted as long as the RMP has regular periodic payments directly deposited into a bank account.
-
- Single Premium Immediate Annuity – For a spouse a level payout annuity can preserve assets. For a single individual the same is true; however, the state must be named a primary beneficiary.
-
- Rental Property – However, the net value of the rental income will be counted toward the Patient Liability.
-
- Asset Protection Annuities – For a spouse a level payout annuity can preserve assets. For a single individual the same is true; however, the state must be named a primary beneficiary.
-
- Half-A-Loaf – This involves transferring all assets above the limit to a trustworthy individual. An IMMEDIATE application is filed with The Department of Children and Families for denial due to transfer of assets. The penalty period is imposed and the clock begins running. The transferred funds are then used to private pay the Nursing Home (these funds are considered as returned to the Medicaid recipient.). The math is done so that each payment to the Nursing Home reduces the penalty period until the combination of penalty period time served and return of assets deletes the uncompensated transfer.
-
- Personal Services Contract – This method of asset protection can only be accomplished with the assistance of an attorney and involves a lump sum payment to a Service Provider( assisted living facility or nursing home) by the service recipient( senior or disabled person).
|
