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Three Criteria for Medicaid Planning and Medicaid Applications

Three Criteria for Medicaid Planning and Medicaid Applications: A Radio Interview of Attorney John R. Frazier by Attorney Joseph Pippen

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Attorney Pippen:

Okay. We have Attorney John Frazier on the line this morning. John is our Medicaid/VA Planning Attorney. Good morning, John.

Attorney Frazier:

Hey, Joe, how you doing today?

Attorney Pippen:

I’m doing great, and you?

Attorney Frazier:

Doing great.

Attorney Pippen:

John calls in a weekly and has the Medicaid Tip of the Week, Medicaid/VA Planning Tip of the Week. So what are we talking about today, John?

Attorney Frazier:

Today, I’m going to talk about the three criteria for Medicaid planning and Medicaid applications, and why that’s important. I think the reason why these criteria are so important is that the average cost of care in a skilled nursing facility here in Florida, it’s about $9,500 per month. I see average costs ranging from $7,500 a month, all the way up to $17,000 per month/. For an assisted living facility, I see costs from $1,500 a month, all the way up to $7,000 per month. And, these three criteria for Medicaid planning give us quite a bit of certainty in our Medicaid planning cases. Because if the Medicaid applicant meets these three criteria, the State of Florida, the Florida Department of Children and Families, has to approve the Medicaid case.

So the three criteria, we have healthcare criteria, we have asset limits, and we have an income limit here in Florida. The healthcare criteria is typically not a problem in my Medicaid planning cases, because most of my clients are over the age of 65 and already in a nursing facility. About 90% of my clients are in nursing facilities. About 10% of my clients are looking for Assisted Living Medicaid. So, the State of Florida says that because this is such an expensive program for the taxpayer, on average, about $7,500 a month or more in taxpayer money to subsidize this program, the State of Florida has a medical criteria, which is evaluated by the Florida Department of Elder Affairs, called the CARES Unit, which stands for the Comprehensive Assessment and Review for Long-Term Care Services group. And in each case, the CARES Unit member will evaluate the medical records and typically visit the Medicaid applicant in the facility to make sure that the person has a medical need to be in the facility.

The next criteria for in Florida, we have asset limits. There’s a $2,000 asset limit for an unmarried Medicare account.

Attorney Pippen:

John, John.

Attorney Frazier:

Yeah.

Attorney Pippen:

Let me ask you a question about the first one first.

Attorney Frazier:

Yeah, sure.

Attorney Pippen:

So basically I always like to summarize this when I’m talking to clients about, Well, you have to not be able to do some major function for yourself: feed yourself, dress yourself, some major health reason prevents you from doing a normal major activity. Would that be a good explanation of the health test summary of what could make you qualify?

Attorney Frazier:

They’re referred to as the activities of daily living. Being able to bathe oneself, being able to walk, being able to eat. If you have an individual who’s been placed in a nursing facility and they’re over the age of 65, that’s really already been determined by the physician. In order to be admitted to a nursing facility here in Florida, you have to be admitted by a physician. So it’s like being admitted to a hospital. You can’t just check into a hospital and you can’t just check into a nursing facility, you have to be admitted. So as long as the person is over the age of 65, those activities of daily living, we already know they’re significantly impaired.

And, the only question mark that we have is if the person is under the age of 65, which I do have, I’ve had, unfortunately, some situations where we have early onset Alzheimer’s, individuals with severe head injuries, sometimes in their 30’s. I’ve had several cases where we’ve had motorcycle accidents. So if the person is under the age of 65, the person has to be classified as disabled under Social Security. If they’re not disabled under Social Security, then the Department of Children and Families requires a separate unit called the District Medical Review Team to determine that the person is classified as disabled if they’re under the age of 65. So, that’s a basic overview of what we have for a person who is either 65 or older or under 65. So does that clarify that?

Attorney Pippen:

Yes, that’s great. So you also said that about 10% of your clients that are trying for Medicaid are in assisted living. Tell us how a person in assisted living would qualify.

Attorney Frazier:

Well, unfortunately, as most people know, if you, if you watch the news, we have a very extensive federal deficit, and here in Florida, because we do not have sufficient taxpayer money to pay for all the government programs that are out there, we have a waiting list for Assisted Living Medicaid. So the very first thing that we have to do when we’re applying for Assisted Living Medicaid is to contact the Area Agency on Aging. There are a number of units throughout the State of Florida, depending on your location.

So what we do is if we’re contacted regarding Assisted Living Medicaid planning, our very first step is to put the Medicaid applicant on that Assisted Living Medicaid waiting list. And, there’s a scoring system on a form called a 701S form, which has a score of between a 1 and 8. And, what we need to do in order to have the person on the waiting list the shortest of time, our goal is to get a score of a 5 on the 701S form. If the person gets a score of a 5, then they’re only going to be on that waiting list 30 to 60 days. I have extensive experience in dealing with this 701S form. And if you answer these questions properly, you’ve got a very good chance of getting a score of a 5 if you’ve got an individual who actually needs to be in an assisted living facility. So that’s how Assisted Living Medicaid works.

Attorney Pippen:

All right, very good. So let’s go into the asset limits.

Attorney Frazier:

We have asset limits. So if you’re an unmarried person, you have a $2,000 asset limit. If you’re married, you have a $3,000 asset limit if both spouses are applying for Medicaid. If you have one spouse applying for Medicaid, one spouse in the community, the asset limit is $130,380 in countable assets. Your Florida house and a car are exempt. House is exempt up to $603,000. If you have a spouse living in the house, there’s no asset limits, so you could literally be living in a $5 million house and still get Medicaid if your spouse is living there. Then the third criteria for Medicaid is we have an income limit. Well, Florida is known as an Income Cap State, and that income limit this year is $2,382 a month in gross monthly income. The State of Florida derives this number from the SSI rate, Supplemental Security Income. So if you take that number for 2021 multiplied by three, you get $2,382 a month.

So, an example of that is, let’s say that you have a Medicaid applicant with $3,000 a month in Social Security, and $1,500 in the checking account, just under $2,000. If we establish this Qualified Income Trust, once that trust is established, we open a new checking account. Each month, we would take most of the Medicaid applicant’s monthly income, put it into this new income trust checking account. The Medicaid applicant is allowed to keep $130 a month, called the Personal Needs Allowance. And then each month we would take $2,870 per month in that example, put that into the Income Trust, pay the nursing facility out of the Income Trust that amount, and that would cover the entire cost of the person’s care. So you can see from that example, if you have an individual like that, you’re going to save tens of thousands of dollars a year by applying for Medicaid. So those are your three basic criteria for Medicaid.

Attorney Pippen:

Yeah, John, so many people come in, I’m sure your clients come in and talk to me about this and they think they have to spend down. They have to get down to those limits by spending down, paying for nursing home, doing this and that. And, so often you and your planning can just protect almost a person’s entire estate, so they have a legacy of assets to leave behind and they can maximize to what they’re really entitled to under Florida law and US law under the Medicaid umbrella, and protect their estate and have a legacy. And there are so many exempt assets. And then we’ve talked about this before about exempt assets, and the homestead’s exempt, and they are ways to create, for you to create exempt assets.

So, if a person has someone in a nursing home or about to go in a nursing home and want to talk about protecting their assets and qualify for Medicaid, John, why don’t you give your personal information here, your office information, about how they contact you.

Attorney Frazier:

The office number is (727) 586-3306, extension 104. My cell phone is (727) 748-5374. And my email address is John@attypip.com.

Attorney Pippen:

All right. So that cell number (727) 748-5374?

Attorney Frazier:

Yeah. (727) 748-5374.

Attorney Pippen:

All right. Well, John, thank you so much for the information on the three criteria for Medicaid planning and Medicaid Applications. I wrote all that contact info down myself here. I knew everything, I don’t always memorize your cell number, but I got everything else. Somebody calls me during the show and wants that or emails me, I’ll be glad to send that on and thank you so much for calling in today.

Attorney Frazier:

All right, thanks and have a great Sunday.

Attorney Pippen:

All right, John, thanks.

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