MEDICAID
Some Frequently Asked Questions
Q: Will Medicare or private health insurance pay for all or part of long-term nursing home care?
A: NO. There are only short-term benefits available, if any at all.
Q: If a person qualifies for Medicaid, will Medicaid pay for nursing home or hospital care?
A: YES. Subject to certain requirements, Medicaid will pay for the entire cost of care. In general, recipients must pay their income to the facility. They will be allowed to retain a $160 personal needs allowance and enough to pay medical premiums.
Q: What kind of assets could Medicaid require be spent before a person is eligible?
A: Such assets as cash, savings, stocks, life insurance cash values, real property, etc. With proper planning and competent advice, applicants can still qualify for benefits.
Q: What assets can I keep and still be eligible for Medicaid Benefits?
A: Basically they are: personal residence of any value if a spouse or minor child is living there or up to a value of $713,000 if you are a single individual, one automobile, whole life insurance with total face value under $2500, term life insurances, burial plots, burial fund to $2500, irrevocable burial of any value, household furnishings, wedding rings, IRAs when a distribution is in place, savings of $2000 in cash for a single person and if married, $154,140 in cash for your spouse. Also, DCF counts income-producing property as income, not asset.
Q: Must I contribute all of my income to the nursing facility in which I reside?
A: The applicant may retain $160 of their monthly income to use for personal expenses such as haircuts and personal items. They may also retain enough income to cover their medical expenses, such as Medicare Supplement premiums, Dental premiums, hearing aid lease payments, etc.
Also, if there is a spouse living in the community, the spouse may qualify to retain a portion of the institutionalized spouses income to help them meet their shelter needs in the community.
MEDICARE vs MEDICAID
Medicare and Medicaid, although they sound similar are as different as night and day.
Medicare
Medicare is given to people age 65 and older or people who have been disabled for 2 years. It is entirely a federal program.
Medicare covers nursing home charges on a short term basis for a maximum of 100 days for “skilled” nursing care. Medicare pays 100% of up to the first 20 days of skilled care and then there is a daily co-pay for the remaining up to 80 days. A patient needs to meet certain criteria in order to remain on skilled benefit.
Medicare is a program which expects you to pay co-insurance amounts which go up each year and is usually covered by a Medicare supplemental insurance if you have that type of coverage.
Medicaid
Medicaid is a federal program but is state regulated in that each state has their own rules and regulations.
Medicaid covers long term nursing home charges in most skilled nursing facilities for those who qualify. There is also coverage for care in some assisted living facilities and for at home care, although funds for those programs are limited.
Recipients of Medicaid benefits must be disabled or 65 years of age in order to qualify.
Applicant for nursing home Medicaid coverage usually must pay all but $160 of their monthly income. Exceptions include examples where there is a community spouse who needs some of the nursing home spouse’s income to meet shelter expenses at home.
Medicaid also now allows a recipient to keep enough income to pay for their Medicare supplement coverage, in addition to any other health insurance or dental premiums.
When a Medicaid recipient resides in a nursing home there is a patient responsibility that is due to the facility. This amount is calculated by the Medicaid caseworker at Department of Children and Families. It is based on GROSS income prior to any deductions that may be coming out of the income sources such as insurance premiums, tax withholding, union dues, etc.
From the gross income amount, the caseworker subtracts any health or dental premiums in addition to $160 personal needs allowance. The final net amount equals the Medicaid recipient's monthly patient responsibility due to the facility.
If the Medicaid recipient has a spouse living in the community, that spouse may be entitled to keep some or all of the Medicaid recipient's income. The community spouse's income and shelter expenses will need to be provided in this case.
Links of Interest
- Florida Medicaid Consumer Information (AHCA)
About Florida Medicaid | Administration and Funding | Eligibility for Medicaid Services Medicaid Headquarters | Medicaid Fiscal Agent | Medicaid Policies and Publications Recent Medicaid Presentations | Advance HIPAA Handbook Updates | Beneficiary Services About Florida Medicaid Medicaid is the state and federal partnership that provides health coverage for selected categories of people with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children. Medicaid is different in every state. In Florida, the Agency for Health Care Administration (AHCA) develops and carries out policies related to the Medicaid program.
- Seniors Blue Book of Southwest Florida
Seniors Blue Book is a comprehensive source for local resources for aging well. Since 1983, the Seniors Blue Book has helped millions of Seniors & Caregivers navigate the confusing world of Senior Housing, Senior Care, Community Resources and Additional Services. Seniors Blue Book is there to help you find the information you need, when you need it most.
Documents & Links for Medicaid
| Isenhour Senior Services (Documents List) | View / Download |
| Medicaid (Eligibility Chart) 2024 | View / Download |
| Florida Long Term Care | FL Medicaid Health Plans |
| Managed Care Plans | View / Download |
| Navigating the Maze of Medicaid 2024 | View / Download |