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.

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.