A Medicaid Primer Review For You

A Medicaid primer review for you to be able to make better decisions. Let’s review some of the basics of Medicaid coverage for those going into nursing homes or skilled nursing facilities.

Medicaid is our country’s second largest health program in terms of expenditures, only trailing Medicare, but it’s the largest in enrollment. The U.S. Department of Health and Human Services’ 2016 actuarial report found that Medicaid insured 70 million people across the country in 2015.

Medicaid was enacted in 1965 by the same legislation that established Medicare. It’s an entitlement program that provides assistance to all individuals who meet the criteria for eligibility. The beneficiaries include the poor elderly and is a primary source of long-term care coverage in the U.S.

Medicaid is financed through a federal-state partnership, and each state coordinates its own program. The total federal and state Medicaid spending was roughly $532 billion in FY 2015.

 

Medicaid Primer Review: Who Is Eligible?

Those who qualify for Supplemental Security Income (SSI) automatically qualify for Medicaid in Florida.

 

Nursing Facility Services: Who is  Eligible?

Medicaid provides nursing facility as a setting for care and services from Medicaid-certified nursing homes. These facilities provide three types of services:

  • skilled nursing or medical care and related services;
  • rehabilitation for injury, disability, or illness; and
  • long-term care.

The Medicaid-provided long-term care is health-related care and services that’s above the level of room and board and isn’t available in the community, but required regularly due to a mental or physical condition.

States can’t limit access to the nursing facility services or make it subject to waiting lists, as they can for HCBS (home and community-based services). HCBS provide opportunities for Medicaid beneficiaries to receive services in their own home or community instead of in institutions or other isolated settings.

The need for nursing facility services is defined by the State of Florida, which has created criteria for nursing facilities. State level of care requirements must provide access to individuals who meet the coverage criteria defined by federal law.

Contact Us

If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.

 

Medicaid Expansion in Florida

Medicaid Expansion in Florida has not happened and does not look likely to happen at this writing. Some states expanded their Medicaid programs under the Affordable Care Act (ObamaCare) to cover all people with household incomes below a certain level. Two years ago, the Florida Senate approved a Medicaid expansion plan, but it was rejected by Governor Rick Scott and the State House.

Regardless of state Medicaid expansion, to qualify for the Florida Medicaid benefit program, you must be:

• A resident of Florida;
• A U.S. national, citizen, permanent resident, or legal alien;
• In need of health care/insurance assistance;
• Whose financial situation would be characterized as low income or very low income; and
• Be age 65 or older.

Medicaid Expansion in Florida Costs The State Money

As of July 2017, Florida is one of 19 states that haven’t expanded Medicaid.

Families USA explained that Florida’s decision not to expand Medicaid means about 1.25 million Floridians don’t qualify for Medicaid, even though their incomes are under 138% of the poverty level.

According to the Robert Wood Johnson Foundation and the Urban Institute, Florida’s economy is negatively impacted by not Medicaid expansion in Florida. The state was projected to lose out on $66.1 billion in Medicaid funding (more than any other state) over the decade starting in 2014 because it isn’t expanding Medicaid. But that’s based on the assumption that the ACA (ObamaCare)—including Medicaid at the currently-scheduled federal funding level—would still be in in effect. Any new legislation implemented under President Trump may affect that program.

The Repeal of ObamaCare: What is the Cost to Florida

Florida stands to lose more than it gains under the proposed the American Health Care Act, which has a spending limit or per capita caps for each person enrolled in Medicaid beginning in 2019, with annual adjustments for medical inflation. Anything spent above the cap, the state would have to cover. With Florida’s spending for Medicaid at or near the bottom of all states, its spending cap will most likely to be lower than the national average.

In addition, the rate of Medicaid enrollment in Florida among disabled persons and low-income seniors, who are the most expensive populations to cover under the program, has increased more quickly than national averages over the past decade. From 2006 to 2015, Florida’s low-income elderly population, seniors who earn less than $24,000 a year for an individual or $32,000 a year for a two-person household, increased 25% compared to the national average of 14%. Plus, the rate of Floridians who qualify for Supplemental Security Income (SSI) also has been higher than the rest of the nation by 35%. The national average is just 17% (SSI beneficiaries are automatically eligible for Medicaid).

Contact Us
If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.

Medicaid Planning For A Spouse: Essential Information You Need to Know

Medicaid planning for a spouse requires special attention. While the concept of spending down to become eligible for Medicaid is important to understand, with married couples, any spend-down efforts should be taken only after the unhealthy spouse moves to a nursing home where this would affect the “community” spouse’s resource allowance. (the community spouse is the one still living in the community, not at a nursing facility).

Medicaid has some special protections for the spouses of Medicaid applicants to ensure that the spouses have the minimum support needed to continue to live at home or outside of a nursing facility while their husband or wife is receiving long-term care benefits in a facility.

Spousal Protections in Medicaid Planning

If the Medicaid applicant is married, the countable assets of both the community spouse and the spouse living in the nursing facility are totaled as of the effective date of the Medicaid application. Sometimes this is referred to as the “snapshot” date because Medicaid is taking a picture of the couple’s assets as of this date.

To be eligible for Medicaid benefits, a nursing home resident may have no more than $2,000 in assets. Typically, the community spouse is entitled to retain half of the couple’s total “countable” assets up to a maximum of $120,900 in Florida. This Community Spouse Resource Allowance is the most that Florida will allow a community spouse to keep without a hearing or a court order.

As an illustration, if a couple had $100,000 in countable assets on the snapshot date, the community spouse could keep the entire amount, rather than just half.

Income of the Community Spouse

The community spouse’s income isn’t counted in determining the Medicaid applicant’s eligibility… just the income of the applicant. As a result, if the community spouse is still working, he or she won’t have to contribute to the cost of caring for her spouse in a nursing home if he’s covered by Medicaid.
However, in some states if the community spouse’s income exceeds a certain threshold, he or she must make a monetary contribution towards the cost of the institutionalized spouse’s care. The community spouse’s income isn’t considered in determining eligibility, but there’s a subsequent contribution requirement.

Contact Us
If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.

Spending Down to Qualify for Medicaid May Not Be Necessary

Spending Down is a common term you will hear if you are looking to get Medicaid coverage for nursing home care and it is possible to avoid having to do that. It’s not uncommon for individuals who apply for Medicaid to discover that they have too many assets to qualify for the program. Remember, Medicaid is a “needs-based” program, and eligibility is based on an applicant’s inability to pay for his or her own care.

Spending Down Further Explained

Federal law establishes a cut-off for the amount of resources an individual may own and still qualify for the program. Those with too much income or assets to qualify for Medicaid must get rid of their excess income. Spending down is the process of an applicant reducing the value of his or her assets to qualify for Medicaid.

Some people believe that there’s just one way to reduce the value of one’s assets… to spend them on the Medicaid applicant’s medical care. However, there are several expenditures that will reduce the value of the applicant’s estate that will enable Medicaid eligibility.

For many of the groups eligible for Medicaid, income eligibility is determined with regard to the Federal Poverty Level (which changes every year). If the household income of a person in Florida eligible for Medicaid is less than a certain percent of the Federal Poverty Level, he or she will meet the income requirements. These percentages vary based on family size and eligibility group, such as age or disability. Medicaid eligibility for Florida seniors is based on the Social Security Administration guidelines for recipients of supplemental security income (SSI). To be eligible for Medicaid, applicants must have no more than $2,000 in “countable” assets (the amount may vary by state).

Non-Countable Assets

There are some assets that don’t have to be spent or sold to qualify for Medicaid—these types of assets don’t need to be spent down.

Examples of some of the non-countable assets include prepaying funeral expenses, paying off a mortgage, home repairs, and paying for more care at home, as well as a limited amount of cash ($3,000 for a couple), when both are applying for Medicaid.

The determination of whether any of these assets are exempt, and to what extent, however, is made on an individual case basis. Florida’s Medicaid program will consider state laws and factors such as marital status and living arrangements.

Contact Us
If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.

Medicaid Eligibility: What You Need To Know

Medicaid eligibility gets complex when you want to get coverage for nursing home care. Medicaid is a joint federal and state program that provides health coverage to over 72 million Americans, including seniors and individuals with disabilities. It’s the largest source of health coverage in the U.S. To participate in Medicaid, federal law requires states to cover certain groups of individuals, such as those receiving Supplemental Security Income (SSI)…typically the elderly.

 

Financial Eligibility for Medicaid

The Affordable Care Act (ObamaCare) established a new calculation for Medicaid eligibility, which is based on Modified Adjusted Gross Income (MAGI). Using one set of income counting rules and a single application across programs makes it easier for people to apply and enroll in the appropriate program. The MAGI-based methodology looks at a person’s taxable income and tax filing relationships to determine their financial eligibility for Medicaid.

Exemption from MAGI Rules. Those whose eligibility is based on blindness, disability, or age (65 and older) are exempt from the MAGI-based income counting rules. Instead, Medicaid eligibility for those age 65 and older or who have blindness or a disability is determined with the income methodologies of the Supplemental Security Income (SSI) program administered by the Social Security Administration.

Medicare Dual Eligibility. Eligibility for the Medicare Savings Programs, where Medicaid pays Medicare premiums, deductibles, and/or coinsurance costs for beneficiaries eligible for both programs is termed “dual eligible.” Their eligibility is determined using SSI methodologies.

 

Medicaid Eligibility in Florida

Medicaid is a federal program, but it’s administered by each state individually. The Federal Government has enacted laws concerning the program, but each state has flexibility that allows it to apply the law differently for its residents.

To qualify for the Florida Medicaid benefit program, you must be a resident of Florida; a U.S. national, citizen, permanent resident, or legal alien; in need of health care/insurance assistance; whose financial situation would be characterized as low income or very low income; and be 65 years of age or older. Over 75% of all Florida Medicaid beneficiaries are now enrolled in managed care plans, such as health maintenance organizations (HMOs).

If you’re eligible for Medicaid in Florida, you can enroll at Healthcare.gov or apply online at ACCESS Florida. There’s also a paper form. This application is for aged or disabled individuals who aren’t currently receiving Supplemental Security Income (SSI).

 

Contact Us

If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.

The Future of Medicaid

To look at the future of Medicaid it is useful to look at where we are now. Medicaid finances more than 16% of all personal health care spending in the U.S., and a recent report from The New York Times found that 42% of Medicaid spending is earmarked for services such as nursing home care.

If the current version of the Senate American Health Care Act is passed, it would have a significant impact on the elderly, perhaps exerting pressure on nursing home operators to cut back their services. The Congressional Budget Office stated that the Senate’s bill would cut Medicaid by more than $770 billion over the next 10 years.

Elderly Living in Nursing Homes

The proposed rollback in Medicaid funding could mean difficulty for the elderly residing in or considering a move into a nursing home. According to the American Health Care Association (AHCA), a national association for nursing homes, the proposed cuts to Medicaid could result in the average nursing home eventually experiencing deficits of hundreds of thousands of dollars annually.

Elderly Americans receive medical coverage from Medicare; however, that program does not cover the costs of long-term stays in nursing homes. Typically, seniors pay out of their own savings for nursing home care. When those savings run out, residents will apply for Medicaid to cover their stay.

The proposed American Health Care Act would repeal of the Affordable Care Act (commonly known as “ObamaCare”), as well as its expansion of Medicaid. The new legislation also would mean a dramatic change the way Medicaid is financed, creating a per capita cap system. In addition, the Trump Administration may consider new waiver requests from state Medicaid programs. Currently, Medicaid is a state and federal partnership with shared financing and no caps.

Let’s look at some key points in the bill that may affect the future of Medicaid:

Medicaid Expansion

Under the Senate’s bill, the Medicaid expansion of “Obamacare” would be phased out. That means that those seniors who gained coverage through the expansion would once again be without coverage [Their option is to purchase coverage through the individual insurance market.].

Federal Funding

The bill reduces federal funding for Medicaid. With more than half the spending for Medicaid at the state level, that leaves states like Florida that also fund the program with less money to provide to the elderly.

The Future of Medicaid and Nursing Homes

State Medicaid programs, like the one in Florida, must cover nursing homes…but if Florida and other states get less funding from the federal government, it could mean more financial pressure on nursing home operations, which, in turn, may see greater restrictions on eligibility for the Medicaid program.

Medicaid provides critical financial support for those who need to live in nursing homes. With about two-thirds of those in nursing homes counting on help from Medicaid, the Republican cuts to Medicaid would leave many families with astronomical healthcare bills.

Contact Us

If you have questions about Florida Medicaid, Attorney Frazier is a skilled Medicaid planning (with over 2,000 cases completed that helped preserve their family’s savings), estate planning and elder law practitioner. Please contact Attorney Frazier for a free telephone consultation at 727-586-3306 extension 104. If you prefer click here now to send in a contact form and we will call you.