A senior latino couple smiling with the phrase "Qualifying for Medicaid in Florida (5 factors)"

Qualifying for Medicaid in Florida (5 factors)

Medicaid is a joint federal and state program that provides free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Qualifying for Medicaid in Florida can be a challenge for some.

For elderly applicants who qualify for Medicare, typically people aged 65 years and older, Medicaid can provide much needed benefits such as long-term care, health and medical insurance to those who can otherwise not afford it, cash assistance and more.  In addition, competition has driven many private Medicare special needs plans (SNPs), when used in combination with Medicaid, to provide augmented benefits.

To qualify for Medicaid in Florida, an individual will be assessed in five areas for eligibility: immigration and citizenship status, household circumstances, assistance required, income and assets and general health.

1. Immigration and Citizenship Status

In Florida, a person must be a legal resident of the state to receive Medicaid.  That means only US citizens and lawfully admitted non-citizens (such as green card holders) who are resident in Florida are eligible for Medicaid.  Undocumented non-citizens and out-of-state resident citizens of the US cannot successfully apply for Medicaid in Florida. 

2. Household

Medicaid in Florida may be made available to those who care for minor children as dependents in their household.  Applicants will be asked to list the ages and number of children they care for in their home.  Note that many applicants, especially the elderly, may be eligible for Medicaid without this factor. 

3. Assistance

Applicants who require special financial assistance due to any of the following reasons may have an increased chance of qualifying for Medicaid:

  • Agricultural losses
  • Disaster-related expenses
  • Food costs
  • Health care or insurance costs
  • High recurring medical expenses in relation to income
  • Home energy costs
  • Mortgage payments
  • Owning own business
  • Rental housing costs

4. Income and Assets

Medicaid is distinct from Medicare in that it is designed exclusively for those with few assets and little or no income. Qualifying for Medicaid can be a challenge for some elderly applicants who have built up assets during their lifetime or who may have income that exceeds the limit set by their state. Middle-income elderly applicants with some assets may not qualify right away for Medicaid because they are considered too wealthy.  However, these individuals may not be able to pay the unaffordably high costs of long-term care, daily assistance and health services.

In Florida, there are ways to structure higher income and assets to make it possible to qualify for Medicaid.

Applicants who seek experienced legal advice from a Florida-licensed attorney who specializes in elder law and estate planning can create special trusts and other instruments that allow them to qualify for Medicaid while retaining the ability to pass on wealth to future generations.

“Medicaid is distinct from Medicare in that it is designed exclusively for those with no assets and little or no income.”

5. Health

An important factor in qualifying for Medicaid, especially for the elderly, is whether there is a medical necessity.  When making an application, the State of Florida may consider the following health-related circumstances to determine eligibility: 

  • Breastfeeding an infant
  • Difficulty with conducting activities of daily living without assistance
  • Drug or alcohol dependency
  • End-stage renal disease (e.g., kidney failure requiring dialysis or a scheduled or completed transplant)
  • Given birth during the last six months
  • Hereditary blood disorder
  • HIV or AIDS
  • Limb function or length differences
  • Limb loss
  • Mental illness
  • Paralysis
  • Permanently (rated 100%) disabled from a service-connected condition
  • Pre-diabetes or at risk for type 2 diabetes
  • Pregnancy
  • Spina Bifida (not including spina bifida occulta)

Perhaps the most relevant qualifying circumstance to elderly applicants is the need to pay for assistance or long-term care to help with “activities of daily living” or ADLs.  ADLs include the ability to move around without assistance (ambulation,) bathing, dressing, eating, grooming and using the bathroom.

Read about the importance of ADLs in the Medicaid application process

The Importance of an Attorney

Completing a Medicaid application is a complex process that affects not only applicants, but their spouses and extended family.  Assets and sources of income jointly owned by the applicant and their spouse can be affected in ways in which it may be difficult for the non-applicant spouse to cover the expenses of daily living. The Florida Medicaid Estate Recovery Program can take away a Medicaid recipient’s house after they pass away to cover for the expenses paid out during the recipient’s lifetime.

Working with an attorney, rather than “going it alone”, can avoid many of these pitfalls and result in a successful application, protected assets and protected income. 

South Florida Law

Your property and other valuable assets form an important part of what you pass on to loved ones. At the same time, Medicaid presents the opportunity to save significant amounts in long-term care costs but it can also present a threat to your assets if it is not planned correctly. We assist in planning for Medicaid coverage later in life including assistance with completing Medicaid applications and restructuring assets to protect your family home from the Medicaid Estate Recovery Program. 

The attorneys of South Florida Law, PLLC have the experience and resources to handle complex estate planning and Medicaid planning matters in the following areas:

  • Management of cases through probate
  • Drafting of official Wills and formation of Trusts
  • Matters related to creditor access
  • Medicaid application preparation
  • Appealing unsuccessful Medicaid applications
  • Avoiding losing your home due to the Medicaid Estate Recovery Program

If you are in the process of applying for Medicaid in Florida and have assets and income to protect contact us today for a consultation by calling (954) 900-8885 or reach out via our contact form.

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