Ask Jaleh: How Does a Single Person Qualify for Medicaid Coverage, for Skilled Nursing Care?


Video Summary


How does a single person qualify for Medicaid coverage for skilled nursing care?  Well first, you have to fit certain criteria, one of which being either 65 years of age or older or a disabled adult.  You also must have residency status and be a resident of the state of Florida.  Now as long as you're in a nursing home at the time of the application you will be considered a resident of the state of Florida.  You also must have citizen requirements.  You must be a citizen of the United States of America or you can be admitted as a permanent resident to satisfy this requirement.


Most importantly, you must have the medical necessity for skilled nursing care.  One may ask, how do you determine the medical necessity for skilled nursing care?  Well there will be a unit from the Department of Children and Family known as a Cares Unit that will come out to the facility or to your home if you're currently living in your home when the application is made in order to complete an assessment to determine whether or not you are medically needy for skilled nursing care.


Also there are income and asset requirements to be eligible for Medicaid coverage for skilled nursing care.  This is probably the biggest area of concern for most people attempting to gain Medicaid coverage.


Well what are the monthly gross limits for Medicaid skilled nursing care coverage?  The limits did recently change after many years of remaining the same and the current monthly gross income for a single person applying for Medicaid coverage is $2,163.00 per month.  Now there are ways to get qualified for Medicaid if your gross monthly income exceeds the maximum allowance of $2,163.00 per month.  One way is that you can create a Medicaid trust.  This is also known as Miller Trust and this can be accomplished by our office.


The Medicaid trust allows individuals to deposit their funds on a monthly basis and to remit their portion of patient responsibility to the nursing home, thereby leaving any excess funds in the trust.  One caveat of the trust is the trust is irrevocable and upon the passing of the Medicaid applicant the state of Florida is subject to recovery of the money that remains in the trust.  But this is a very useful tool in qualifying individuals for Medicaid.


Also there is an asset requirement for Medicaid coverage.  The asset requirement is that your countable assets may not exceed $2,000.00.  The $2,000.00 in countable assets seems very minimal for most people who have worked very hard their entire lives to gain things such as homes or cars.  Well there are also exempt assets that are not counted as a quote-unquote countable asset for the determination for Medicaid.  Some of these exempt assets which are not countable assets include your homestead residence of value of up to $500,000.00 as long as the applicant intends on returning home, although the applicant in most situations never does return home.


Also you are allowed to have one vehicle regardless of age and regardless of value.  You may have a second vehicle but the second vehicle cannot be a luxury vehicle and it must be seven years or older.  You also can have life insurance policies; however there cannot be a cash value or a face value of more than $2,500.00 for the life insurance policies.  And also a non-countable asset would be a burial fund or a prepaid burial contract.  You can have an irrevocable funeral contract for any amount which is not considered a countable asset.  You also can have a separate account labeled, and it must be labeled burial account, with up to $2,500.00 which can be used for expenses upon your death such as plane tickets for your family members, meals, flowers, things of that nature to assist your family with these expenses.


If you'd like more information on how to qualify for Medicaid as a single person, please give me a call here at Waller and Mitchell.  The phone number is 727-847-2288 and we'd love to help you get qualified for coverage.