Medicaid in Florida provides manifold benefits to those who are eligible.
In many cases, such as with long-term care, it can be difficult to become eligible for Medicaid benefits if you have assets or income over a certain limit. Because these limits are low, many are not eligible. However, working with an elder law attorney with experience in assisting people with Medicaid applications can result in a successful application despite initially having assets and income over the limit.
Before exploring ways to become eligible for Medicaid, it is important to understand the benefits of coverage which include long-term care, non-emergency medical transportation and medical/dental/vision care.
Long-Term Care Benefit
When many people think of Medicaid benefits in Florida, Long Term Care often comes to mind. Indeed, for many of the state’s elderly residents, long-term care is the primary reason to apply for Medicaid.
The reason why the long-term care benefit is so popularly associated with Medicaid is that the costs of long-term care without Medicaid can be prohibitive for most people.
In Florida, for example, it is not unusual that a nursing home would charge between $8,000 and $10,000 per month for their services. Although in-home care can be less expensive, it still can add up to several thousands of dollars per month.
There is a multi-agency process to receive Medicaid’s long-term care benefit in Florida. The agencies involved are The Agency for Healthcare Administration (AHCA), the Statewide Medicaid Managed Care (SMMC) Long-Term Care program, the Department of Children and Families (DCF) and the Department of Elder Affairs (DOEA).
First, there is a screening process where the DOEA decides whether the applicant meets medical eligibility while the DCF decides whether the applicant is financially eligible.
Secondly, successfully screened applicants are placed on a waiting list. Applicants are selected from the waiting list based on need (as assessed by the AHCA) rather than based on how long they have been on the list. The intention of this part of the process is to give the frailest Floridians the first opportunities to receive long-term care coverage. The prioritization of applicants is based on rank, with lower ranks scoring between 0 and 29 and higher ranks being 30 to 46+. In order to determine eligibility at this stage, a representative of the CARES (Comprehensive Assessment and Review for Long-Term Care Services) program, nurse or doctor visits the person’s home to assess their need for long-term care.
If an applicant successfully passes the first and second parts of the process he or she enters a third and final phase where they choose a long-term care plan. Those deemed eligible and who are selected from the waitlist can now receive long-term care services through the SMMC Long-Term Care program. At this stage, the SMMC will send a welcome letter and brochure that explains the program and also explains how to select a long-term care plan.
At each step in the above process, unsuccessful applicants (or successful applicants whose Medicaid benefits have been reduced or stopped) may ask for a fair hearing. After unsuccessfully completing the screening or eligibility stages in the process, applicants have 90 days to request a fair hearing with the Department of Children and Families.
Other criteria exists for those requesting a fair hearing to dispute reduced or ceased Medicaid benefits.
“There is a multi-agency process to receive Medicaid’s long-term care benefit in Florida.”
Non-Emergency Medical Transportation Benefit
Medicaid recipients receive the benefit of non-emergency medical transportation (NEMT) that allows them access to transportation to visit medical centers, medical specialists and hospitals. This service is offered through many licensed vendors located throughout the State of Florida who have expertise in and equipment for transporting elderly and disabled passengers. Typically, NEMT vendors in Florida require booking three days in advance.
Bookings can often be made by phone, online or via a mobile app.
Medical, Vision and Dental Covered Services
Note that most elderly residents in Florida who are eligible for Medicaid are also Medicare recipients. In the case of dual coverage, Medicare is the primary insurance and Medicaid is the secondary insurance. This means that Medicaid pays last and covers costs not already covered or paid for my Medicare.
Besides home health care and long-term care services, Medicaid recipients may receive coverage for the following:
- Allergy Services
- Ambulatory Surgical Center
- Anesthesia Services
- Assistive Care Services
- Behavioral and Mental Health
- Cardiovascular Services
- Chiropractic Services
- Dental Services
- Dialysis Services
- Durable Medical Equipment (DME) and Medical Supplies
- Early Detection/Intervention Services
- Evaluation and Management Services
- Federally Qualified Health Center Clinic Services
- Gastrointestinal Services
- Genitourinary Services
- Hearing Services
- Hospice Services
- Hospital (Inpatient and Outpatient)
- Integumentary Services
- Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Services
- Laboratory Services
- Nursing Facility
- Oral and Maxillofacial Surgery Services
- Orthopedic Services
- Pain Management Services
- Podiatry Services
- Prescribed Drug Services
- Program of All-Inclusive Care for the Elderly (PACE)
- Radiology and Nuclear Medicine Services
- Reproductive Services
- Respiratory Services
- Rural Health Clinic Services
- Therapy Services (Occupational, Physical, Respiratory, Speech-Language Pathology)
- Transplant Services
- Transportation – Emergency
- Vision Care and visual Aid Services
The Importance of an Attorney
An experienced elder law attorney can help applicants become financially eligible for Medicaid.
The benefits of Medicaid in Florida are many and go beyond simply providing long-term care services. Many of these services are not affordable to many elderly Floridians who are covered by Medicare alone. However, many of these Floridians are unable to access Medicaid because they would be deemed financially ineligible.
Working with an experienced elder law attorney can result in a successful Medicaid application that would otherwise have been rejected on the grounds of too much income or too many assets. Assets and income can be legally placed in trust and protected so that they can still benefit a non-Medicaid eligible spouse or children in the form of inheritance.
South Florida Law
South Florida Law is a full-service estate planning, business and real estate law firm that can assist families in employing a variety of strategies during Medicaid means-testing to become Medicaid eligible. We can also proactively work with families, couples and individuals to protect their homes from Medicaid’s Estate Recovery Program. The best time to begin planning for Medicaid is years before nursing home services are needed. That said, when long-term care services are needed urgently, Medicaid’s complexity and the potential savings that can come from expert advice make it essential that you consult with an expert before taking the first step. Contact us today for a consultation by calling (954) 900-8885 or via our contact form.