The Three-Part Test for SNF/ALF Medicaid Qualification In Florida must be met in Florida to obtain coverage.
Medicaid is a federal/state-run program that provides low-cost and sometimes free health coverage/insurance to qualified persons.
The aim of this insurance program is to provide medical care and long-term care coverage to persons who would otherwise, due to financial constraints, go on without medical care.
Eligibility is usually determined based on a wide range of options, including income, age, disabilities, and residency. In states like Florida, an additional eligibility test for aging patients and seniors is required before they can qualify for Medicaid benefits.
Medical Home Care Options For Seniors
In healthcare, ALF and SNF are two very popular terms. ALF is an acronym for “assisted living facility,” while SNF is a short form of “skilled nursing facility.” In the past, the term “nursing home” was used instead of SNF, and many people still use the term nursing home for SNF.
While both ALF and SNF are commonly used when referring to the medical care given to aged patients, they both do not mean the same thing. Additionally, to get either of them covered will require meeting the three-part test for SNF/ALF Medicaid Qualifications in Florida.
ALF is for seniors who do not require as much medical care but need assistance with the basic activities of daily living (ADLs), such as providing assistance with bathing, dressing, eating, medications, and movement.
SNF (or nursing home if you prefer), on the other hand, are homes for seniors who require significant and sometimes specialized medical care and attention.
Whereas assisted living offers more of a residential setting, skilled nursing is more of a medical setting. Florida Medicaid covers both SNF and ALF options for aged persons who require medical care. However, there is currently a waiting list for ALF Medicaid.
The Three-Part Test for SNF/ALF Medicaid Qualification In Florida – The Three Core Eligibility Tests
A core part of benefitting from the Florida Medicaid for SNFs/ALFs is meeting the eligibility requirements. The three-core eligibility tests that every applicant must satisfy to be entitled to receive the ALF, home health care, or nursing home/SNF benefits include:
#1. Medical Necessity Test:
The Medicaid medical-necessity test seeks to ascertain and confirm that the applicant actually needs the care.
This test is usually carried out through the help of a doctor. A caseworker from the Florida Department of Elder Affairs determines the medical eligibility for the SNF/ALF Medicaid applicant.
#2. Medicaid Asset Limits Test:
In order for a single individual over the age of 65 (with exceptions for younger, disabled Medicaid applicants) to qualify for an ALF or SNF, he/she must not have more than $2,000 in countable assets.
This clause is included because not all assets are counted—thankfully. Some exemptions on countable assets include home furniture, personal belongings, automobile, etc.
If it is a married couple applying for long-term care benefits, they must have no more than $3,000 in what Medicaid refers to as countable resources combined. Your home is not a countable resource up to $595,000 in 2020 (If your spouse is still living in the home, there is no asset limit for the home).
It becomes more daunting qualifying for Medicaid when it is both partners seeking help. However, when it is just one of them, it then is often easier to qualify.
The community spouse will then become entitled to a community spouse resource allowance (CSRA) of $128,640 in 2020, while the Medicaid spouse will be given $2,000. In total, they’ll both be allowed to have $130,640.
#3. Medicaid Income Limits Tests:
For Medicaid eligibility purposes, income is classified as any amount that a Medicaid applicant receives. This can come from a wide range of sources, including alimony payments, social security income, pension, and so on. In Florida, this amount changes from time to time. As of January 2020, it was $2,349 monthly.
DCF will make inquiries as to how much the applicant earns from all gross income sources and will total them. If the total gross amount is more than the income cap amount, then a Qualified Income Trust is required.
It is important to note, though, that when only one spouse is applying for SNF/ALF Medicaid help, only the income of the applicant is regarded. Meaning that the income of the non-applicant or the healthy spouse is not used to determine Medicaid eligibility.
If you or your loved one does not currently meet the eligibility requirements for SNF/ALF Florida Medicaid, you should contact an elder law attorney. Get in touch with us today for your free telephone consultation.
Attorney Frazier has successfully helped over 3,000 people to obtain coverage for SNF/ALF Medicaid. He will tell you if he thinks he can help you or not in meeting the three-part test for SNF/ALF Medicaid Qualification in Florida in your consultation. You have nothing to lose and everything to gain from talking with Attorney Frazier.
See now more frequently asked questions if you desire.