Qualifying for Medicaid When You Exceed the Limits

Qualifying for Medicaid for nursing home care can be complex. For those Florida residents who are age 65 and over who don’t meet the eligibility requirements for Florida Medicaid Long Term Care Eligibility for Seniors, there are other ways to qualify for Medicaid. Here are some details on these options.

 

Medically Needy Pathway to Qualifying for Medicaid

An individual may still be eligible for Medicaid services even if he or she is over the income limit if he or she has high medical bills that meet a threshold.

These bills include health insurance costs, such as Medicare premiums and bills to cover medical services. The Medically Needy Program, which is also known as a “Share of Cost” Program or a “Spend-Down” Program, is based on a person’s “excess income.” That’s their income over the Medicaid eligibility limit (also called their “share of cost”) that’s used to pay their medical bills.

After a person has paid down their excess income to the Medicaid eligibility limit, Medicaid will apply for the month. This program gives them a way to spend down extra income to qualify for Medicaid.

However, the Medically Needy Pathway doesn’t help a person in spending down extra assets for Medicaid qualification. So, if an individual satisfies the income requirements for Medicaid eligibility but not the asset requirement, this program can’t help him or her in “spending down” extra assets. However, the individual can “spend down” assets by spending excess assets on non-countable assets—like home modifications, such as the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt.

Medicaid Planning

Most people considering Medicaid are “over-income” or “over-asset” or both, but they still can’t afford their cost of care.  For those in this situation, there’s Medicaid planning that can help you in qualifying for Medicaid.

Medicaid planning attorney John Frazier can assist families in devising strategies to help them become Medicaid eligible.

 

Contact Us

If you have questions about Florida Medicaid and Medicaid planning, Attorney John 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 John 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 get in touch with you.

 

 

What is Informed Consent?

Informed consent is necessary in Medicaid Planning. The State of Florida Department of Children and Families, Department of Elder Affairs requires an assessment for all those applying for or receiving assistance for long term care (LTC). This includes the Institutional Care Program (ICP). Every individual who applies for the program must give his or her consent to this assessment.

 

Informed Consent

Generally, informed consent means that the person who is to undergo a medical procedure or, in this case an assessment, has been given an explanation and understands the risks of the outcome.

Florida’s general informed consent law requires that for a patient to give valid, informed consent to any medical treatment, the health care professional must conform to “an accepted standard of medical practice among members of the medical profession” and provide information the details the following:

  • the nature of the procedure;
  • the medically acceptable alternatives to the procedure; and
  • the procedure’s substantial risks.

To evaluate a senior’s needs for eligibility for the Institutional Care Program, they must sign an informed consent form.

 

Granting Permission to the Agency

By signing Form 2040, the applicant is specifically giving the agency permission to the following:

  • An assessment to identify the individual’s need for long term care and to determine if his or her needs can be satisfied in the community or in a nursing facility; and
  • Access to the person’s medical records by DC&F and DOEA staff. This also means that they have permission to speak to the individual’s doctor and other health professionals, as well as family members, close friends, and social services professionals about the person’s situation.

The information DC&F requests is used to determine eligibility for health coverage, to ascertain the patient’s state of disability, and to carry out treatment, payment, or health care operations.

The informed consent is time-limited and is valid for only a specific period of time. The patient has the right to revoke or cancel the authorization at any time.

 

Unable to Give Informed Consent

If a person can’t provide informed consent due to incapacity, the hospital or doctor will consult with his or her health care surrogate or agent who’s been entrusted to make the decisions on behalf of the incapacitated person.

It’s important to sign a healthcare power of attorney to designate a trusted person to act on your behalf if you’re incapacitated and can’t give your informed consent. Without this document, the State of Florida provides a list of individuals who can make decisions for you: your guardian is first, then, your health care surrogate, your spouse, then your children, your parents, and then siblings.

 

Questions about Informed Consent and Medicaid Forms?

If you have questions about informed consent or Florida Medicaid assessments, contact attorney John Frazier, 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 John 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.

Facts About Medicaid Income Eligibility in Florida

The Facts About Medicaid income eligibility in Florida include several strict requirements, including the following:

  • Medicaid applicant’s own monthly income can’t exceed $2,205 (in 2017), but there’s no limit on the applicant’s well spouse (“Community Spouse” or the spouse not receiving care);
  • A married applicant may be allowed to credit some part of his or her monthly income above the $2,205 limit for the support a community spouse if that spouse’s monthly income is less than approximately $2,000; and
  • Any excess income of the applicant after an allowance for the community spouse support must be paid to the assisted living facility or used to fund a Medicaid Trust that he or she creates. That trust income is used to support the recipient during his or her lifetime.

 

More Facts About Medicaid Income Eligibility = Asset Eligibility

The key to coordinating the complex world of Medicaid is to work with an experienced Medicaid attorney.

A Medicaid applicant should partner with a qualified estate planning attorney to properly plan for program eligibility.

In the event that the transfers are intended primarily to achieve Medicaid eligibility and are disallowed, those transferred assets will impact Medicaid eligibility and benefits. Many transfers of assets within five years of a Medicaid application (known as the Medicaid “look-back period”) are presumed to have been intended primarily to achieve Medicaid eligibility.

That’s why it’s vital to map out a complete estate plan as soon as possible based on the facts about Medicaid income eligibility.

 

Florida’ Strict Medicaid Limits

In our state, the Medicaid programs have strict limits on the assets that an applicant can have.

  • An applicant can’t own more than $2,000 of assets in addition to any assets that aren’t counted because the law considers them either exempt or not available;
  • A married applicant’s community spouse can’t retain more than $120,900 of assets;
  • The definition of “assets” includes all assets that are titled in applicant’s name or jointly titled with another person, like the family home.

 

Questions?

If you have questions about facts of Florida Medicaid income eligibility and estate planning, attorney John 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 John 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.

Deposits Needed into Qualified Income Trust Accounts

Deposits needed into a Qualified Income Trust (QIT) allows a person to become eligible by placing their income into an account each month that the individual needs Medicaid. The amount of money to be deposited in the trust each month must be enough so that remaining income is within program standards.

Since the income deposited and withdrawn from the QIT is used to calculate an individual’s patient responsibility, the wise thing to do is to deposit a bit more income to have a small cushion, rather than risking depositing too little and not qualifying for Medicaid.

Upon determining that a person has a patient responsibility, he or she is responsible for paying that amount.

 

Funds Remaining in the QIT Go to the State

Any funds remining in the QIT at death are to be paid to the State (up to an amount of the total Medicaid benefits the State paid on behalf of that person).

When the patient passes away, the QIT trustee or other agent acting on behalf of the patient should contact the long-term care facility to determine if there’s any refund for the month of death due to the trust.

Again, any remaining balance in the QIT as of the date of death—plus any refund from the nursing home facility—must be paid to the State.

Usually all that is needed is a brief cover letter that states that the payment is for a QIT with the Medicaid recipient’s name, social security number, and/or Medicaid ID number. You should enclose a copy of the QIT bank statement covering the date of death to confirm the check is for the balance. In addition, include any documentation of refunds received from the long-term care facility.

 

Contact Us

If you have questions about payment of QIT funds to the State and Florida Medicaid, contact attorney John Frazier, 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 John 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.

 

What is a Qualified Income Trust?

Qualified Income Trust information you need to know. Florida’s Medicaid program has limits for an applicant’s assets: if his or her income is over the limit to qualify for Medicaid long-term care services (including nursing home care), a Qualified Income Trust is the solution. This trust allows a person to become eligible, by placing a portion of their income into a bank account each month that the individual needs Medicaid.

A Qualified Income Trust (QIT) is a written agreement that creates a special account in which a person can make deposits.

A person must have a QIT if their income before any deductions (like taxes, Medicare, or health insurance premiums) is over the income limit to qualify for the program.

Trusts are complex legal documents that require an attorney who practices in this area. Work with an experienced Medicaid trust attorney, to help you set up the QIT agreement, because this trust must meet specific requirements. It also must be approved by the Department of Children and Families Regional Legal Counsel, and a copy of the QIT agreement must be submitted to an eligibility specialist who will forward these documents for review. An experienced attorney will know the procedures and guide your paperwork through the steps.

Qualified Income Trust Requirements

A QIT has specific requirements. The agreement must satisfy all the following. It must:

  • be irrevocable, meaning it can’t be canceled;
  • be written so that the State receives all funds in the trust when the person dies (limited to the amount of Medicaid benefits paid);
  • consist only of the applicant’s income without other assets; and
  • Be signed and dated by the applicant, his or her spouse, or the individual with legal authority to act on the applicant’s behalf (Power of Attorney).

How does A Qualified Income Trust account work?

Once the account is set up, the person is required to make deposits into the QIT account every month for as long as Medicaid is needed. This can mean that a deposit is needed before a Medicaid application is approved. But as long as income is deposited into the QIT account in the month it’s received, it won’t be counted against the applicant.

Deposits can’t be made for a past or future month, and any income received back from the trust is deemed to be income. If the applicant skips a monthly deposit or fails to deposit enough income, he or she will be ineligible for Medicaid. (Income placed into a QIT is excluded as income in the eligibility determination; however, it’s counted in the calculation of the patient responsibility).

Questions about a QIT?

If you have questions about QITs, or any issue concerning Florida Medicaid, attorney John 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.

If you want to learn if you or your loved one may qualify, contact accredited VA Attorney Frazier for a free telephone initial consultation at:

727-260-2581

After 5PM: 813-431-3193

If you prefer click here now to send in a contact form, and we will call you.

 

How Does the Institutional Care Program (ICP) Work in Florida?

The Florida Institutional Care Program (ICP) helps people in nursing facilities pay for the cost of their care plus provides general medical coverage. ICP eligibility is determined by the Florida Department of Children and Families (DCF).

In a nursing facility, patients pay for services through private insurance or self-pay. The other option is Medicare or Medicaid. Medicaid can pay for intermediate and skilled care for an unlimited period of time.

 

Assessment

The Florida Department of Elder Affairs (DOEA) will conduct a Comprehensive Assessment and Review for Long-Term Care Services (CARES) for an applicant. This process will determine the individual’s need of nursing facility services and the appropriate placement.

An important part of eligibility for the Institutional Care Program is financial need. Many applicants will transfer assets to family members or place them in a trust. However, sound planning is a must to accomplish this because the state has a “look-back” period for most asset transfers of five years prior to the application month.

This means that any transfer of assets within five years of applying for Medicaid in Florida may be counted as still belonging to the applicant when determining the monthly income limit of $2,200.

 

Eligibility Requirements

Here is a list of some of the eligibility requirements. An applicant must:

  • be age 65 or older, or disabled as determined by Social Security criteria;
  • be a U.S. citizen or qualified non-citizen;
  • be a Florida resident;
  • have a Social Security number or apply for one;
  • file for any other benefits, such as pensions, retirement, disability benefits, if applicable;
  • inform DCF of any third-party health insurance;
  • be determined to be in need of nursing facility services;
  • be placed in a nursing home that participates in the Medicaid program; and
  • have assets and income that are within the program limit.

 

 Spousal Allowance

In the case of married couples, the assets and income are evaluated when one spouse is institutionalized and one spouse continues to live at home (the “community spouse”). The community spouse may be eligible to receive some portion of the institutionalized spouse’s income.

 

Questions about Applying for Medicaid?

If you have questions about the Florida Medicaid application process, contact Medicaid attorney John Frazier. He’s 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 John 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.


 

What are Exempt Assets for Medicaid Eligibility?

Exempt assets for Medicaid eligibility varies state to state. Florida implemented a new system for long-term care services through Medicaid three years ago. The program is called the Statewide Medicaid Managed Care Long-Term Care Program. In this program, Medicaid-eligible seniors who require long-term care can receive assistance in their home, in the community, or in assisted living.

With regard to Medicaid, Florida is what is known as “an income cap state.” That means that to be eligible for Medicaid long-term care benefits, there’s a hard and fast income limit. Here, the state requires the amount to be no higher than its set limit at time of application.

Compare this to a “non-income cap states,” also known as “Medically Needy” states where there is no income limit for Medicaid.

 

The List of Exempt Assets for Medicaid Eligibility

Here’s the list of assets that are exempt from the Medicaid program asset limits in Florida, and don’t need to be liquidated:

  • A Florida homestead is exempt up to $560,000 of equity, and there’s no equity ceiling if the home is occupied by the recipient’s spouse (known as the “community spouse”) or a minor child;
  • One vehicle is exempt, regardless of its year, type, or value. A second vehicle over seven years old is also exempt, except for a luxury or antique vehicle;
  • The applicant’s personal property is exempt, except for certain valuable items of jewelry, art, or collectibles;
  • An irrevocable burial contract is exempt, regardless of amount, plus an additional $2,500 held in reserve for funeral and burial expenses;
  • Life insurance with a face amount of less than $2,500 owned by recipient and spouse are exempt from Medicaid;
  • IRAs, 401k plans, and other tax-deferred retirement investments can be made exempt with the correct legal advice.
  • Income producing real estate is exempt if it isgenerating net income;
  • $2,000 or less in cash or non-exempt assets is exempt for singles, and if the applicant is married, and both spouses require nursing level care, the limit is upped to $3,000.

Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects aren’t counted in the calculations.

 

Questions about Exempt Assets for Medicaid Eligibility?

The application for Medicaid takes some planning and consideration, especially if you have assets that may take you above the income limit. 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 John 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.

Association Says Proposed Rule Hurts Residents

Officials with a Florida nursing home association recently filed a legal challenge to a proposed rule that they say would financially burden assisted living operators in the state and have a negative impact on elderly residents and their families. They also claim that the bill doesn’t recognize differences between assisted living and skilled nursing.

The litigation stems from House Bill 1001, which is known as the “Assisted Living Reform Bill.” The Florida bill was passed two years ago but is now undergoing rule making before some of its provisions become effective.

 

Florida Near the Top in Country for Number of Assisted Living Communities

The nursing home association, Florida Argentum, is the Florida chapter of the national organization, which previously was known as the Assisted Living Federation of America (ALFA).

Florida Argentum represents companies that operate professionally managed senior living communities, such as independent, assisted, and memory care, along with industry partners that serve senior living operators in Florida. Members of the group include the largest assisted living providers in the state.

Argentum says that the legislation and the rules promulgated pursuant to it are critical because Florida has one of the highest numbers of assisted living communities in the country. Argentum believes that the state’s interpretation of its own authority is inaccurate; limiting the power of state agencies to create policies that are deemed not to be supported by statute.

 

Rule Would Institute Difficult Requirements

Florida Argentum claims that the rule proposed by the state Department of Elder Affairs would prevent seniors from aging in place if they have certain medical conditions. The new rule would create requirements that most assisted living communities wouldn’t be able to meet.

For example, a senior resident who’d been treated in the hospital for a urinary tract infection and required IV therapy with antibiotics after she was discharged could receive those services if she were living in a single-family home—however, most assisted living communities in Florida wouldn’t be able to comply with these orders. As a result, the patient wouldn’t be able to receive her services at the assisted living community. The question would then be where she would go to receive the IV treatment. Probably to a rehabilitation center or a skilled nursing facility, Florida Argentum argues, which is excessive for a procedure the elderly woman could normally receive at her home in a care facility.

The organization also said that the proposed rule wants to apply Florida Medicaid requirements to all operators, even for residents not enrolled in Medicaid. That means facilities would be required to assess all incoming residents’ instrumental activities of daily living and develop a care plan at admission.

 

Added Liability Possible

The proposed rule change could also mean increased liability for facilities. The change could lead to increased rates. And assisted living communities could be liable for services provided to residents by third parties.

Challenges of proposed rules like Florida Argentum’s is doing are being presented to an administrative law judge and a hearing is scheduled. The judge then has 30 days to make a decision.

 

Contact Us

If you have questions about the effect of this new rule on a loved one’s residence at a nursing home, Florida Medicaid Attorney John Frazier can help. He’s 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 John 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.

 

Florida Official Charged in Medicare/Medicaid Fraud Case

A Florida state healthcare official was charged with accepting bribes in exchange for helping a nursing home owner who’s accused of coordinating a $1 billion Medicare and Medicaid fraud scheme keep his license.

Federal prosecutors in Florida say that Bertha Blanco is facing federal criminal charges in a broad investigation that federal authorities say is the nation’s biggest health fraud case, according to a report in The Miami Herald.

 

Defendant in Charge of Nursing Home Inspections

Blanco was earning about $31,300 a year managing the inspections of Florida nursing homes. She became involved with the inspections at nursing facilities owned by Philip Esformes, who owns dozens of Miami-Dade nursing facilities, along with facilities in Miami, Los Angeles, and Chicago.

Prosecutors said in the criminal complaint filed against Blanco that she took tens of thousands of dollars in cash in exchange for telling Esformes about violations in his homes so he could correct them prior to state inspections. Blanco allegedly took the bribes and provided patient and inspection records to a third-party, who delivered the information to Esformes. With her help, Esformes was able to retain his license and continue to bill the federal government for questionable patient services, the criminal complaint alleged which if accurate is clear Medicare/Medicaid fraud.

Blanco had worked at the Florida Agency for Health Care Administration for nearly 30 years. She is the first of the agency’s employees ever charged with taking bribes, The Miami Herald reported.

 

Trial Set for SNF Owner

Esformes is currently being held in federal custody as a result of the Medicare/Medicaid fraud. He’s scheduled to go to trial in March of next year. Attorneys for Esformes claim that the intermediaries working with Blanco acted without his knowledge. Two of the intermediaries made plea deals and are expected to testify against Esformes. The two assisted investigators in the indictment of Esformes by taping a cash transaction that prosecutors said was earmarked for bribes.

The nursing home owner is accused of using his 20 nursing facilities to file false Medicare and Medicaid claims for services that weren’t necessary for approximately 14,000 patients. Federal prosecutors say that his healthcare network and other co-conspirators billed $1 billion for fraudulent services from 2009 to last year when he was arrested.

 

Contact Us

Florida Medicaid can be a complex subject to tackle. If you have questions about any aspect of Florida Medicaid, Attorney John 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 John 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.

 

Florida SNFs Suing Managed Care Groups Over Delayed Medicaid Payments

A group of Florida skilled nursing facilities recently filed a class action lawsuit against multiple insurance providers over their delay in Medicaid payments.

The suit was filed in the United States District Court for the Southern District of Florida. It was initiated by a group of 10 skilled nursing operators against seven managed care companies including affiliates of Humana, Molina Healthcare, and United HealthCare.

 

“Gatekeepers to Medicaid Benefits in Florida”

The lawsuit’s complaint said that the companies were the “gatekeepers to Medicaid benefits in Florida.” The plaintiffs are Skilled Nursing Facilities (“SNFs”) who provide healthcare services to, as the describe in the court document, “some of Florida’s most vulnerable citizens—nearly 71,000 elders and individuals with disabilities—many of whom require 24-hour complex medical care…”

The Skilled Nursing Facilities allege that the Medicaid managed care organizations engaged in a “systematic business practice of illegally withholding interest owed on overdue payments” to the providers, who “rely on the prompt payment of Medicaid funds” to deliver care to the plan’s beneficiaries…the residents of care facilities—primarily Florida’s elderly.

Payments that are delivered after the deadline accrue interest at 12% per year. The plaintiffs claim, “Despite receiving proper claims for payment, Defendants have engaged in a pattern and practice of fabricating reasons to delay payments of claims to Plaintiffs, and then paying an improper amount of interest, if any, on overdue payments.”

The suit also claims the insurance companies made up reasons to reject providers’ proper claims and making them “jump through unnecessary, nonsensical hoops.” This, they said, was a purposeful delay in the payments to increase their revenues.

The providers are asking the District Court for declaratory and monetary relief.

 

Outstanding Claims

The Florida Health Care Association has testified in the Florida State Senate in support for the nursing home providers. They have found that many facilities carry more than $200,000 in outstanding claims. The statewide shortfall is nearly $135 million. Some of this shortfall is Medicare Part A (Hospital Insurance), which covers skilled nursing care provided in a skilled nursing facility (SNF) under certain conditions for a limited time.

 

Contact Us

If you have questions about Florida Medicaid, Attorney John 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 John 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 get in touch with you.