Video Summary

Reasons for Medicaid planning.  Medicare or long-term care insurance benefits may be unavailable or insufficient to cover the costs of nursing home institutionalization.

While Medicare and HMOs may pay part of the nursing home care for the first 100 days, they will only pay for quote unquote skilled care, and a three-day hospitalization requirement must be fulfilled before any days of care and coverage will be allowed.  The first 20 days full expenses will be paid by Medicare or Medicaid.  And for the next 80 days the patient must pay a sizeable per day coinsurance amount.

Nursing homes in metropolitan areas of Florida normally charge $250.00 per day or more simply for room and board.  Thus, the Medicare and HMO coverage will not pay the entire bill.  Further, because of the narrow definition of skilled care, the national and Florida average for Medicare and HMO coverage is 10 to 20 days and not the full 100 days allotted.  Long-term care calls for long-term money management to provide essential health and quality of life services and wears over and above that furnished by the Medicaid benefits.  The burden of costs of catastrophic medical care is especially poignant in cases of married couples.  Community spouses who do not plan ahead, often live in poverty to keep an ill spouse in a nursing home.

If you have any questions regarding skilled nursing care and/or Medicaid planning, please give us a call here at Waller and Mitchell at 727-847-2288.

Video Summary

Medicaid Application Process.  A Request for Assistance, which is also commonly referred to as an RFA form is generally used to apply for most Medicaid programs.  With this form, the applicant must file permission steps to allow DCF to check Medicaid, medical and financial records, a form to specify which program is being applied for, and also a doctor’s statement showing the medical necessity of the applicant.

Following receipt of the RFA, the applicant will be notified by a letter containing a request for records the applicant needs to assemble in order to complete their application.  Most records requested are bank statements and other financial records tending to show the financial status of the applicant, such as estate planning documents.

After all information is assembled, the case will be decided and a letter will be sent to the applicant informing them of the grant or denial of aid.  Usually the decision letter is sent within 45 to 60 days of the application date.  It is important to note that it is always best for a lawyer – your lawyer – to handle this process from start to finish, rather than attempting to complete this process individually or through a family representative.  Organization and proper presentment of information is necessary, as is the knowledge of laws, rules and regulations, in order to successfully complete this process.

Also, it’s very important to know that the date of your application is key to determination, since in most instances the grant of benefits will be retroactive to the first day of the month in which the application is processed.  If the applicant is eligible for one day of the entire month, then entitlement is good for the entire month applied for.  Also, the Institutional Care Program entitlement date is the date in which the institutionalization began and the applicant is otherwise eligible.  Another component of the application process is verification of U.S. citizenship.  Another component is verification of residency in the state of Florida at the time of the application.

What types of financial records must be gathered to ensure complete financial disclosure for the Medicaid application process?  Such types of documents include: VA benefits forms and letters, pension benefits, life insurance records, security statements, bank records, deeds, accounts payable such as notes and mortgages, tax bills such as real estate tax bills from the preceding year, vehicle registration, title papers, insurance information such as homeowner’s insurance, disability insurance, life insurance, funeral records, burial accounts, funeral and plot contracts as well as funeral deeds, prenuptial and postnuptial agreements, powers of attorney, utility bills, receipts and other records showing current utility needs, HOA statements and dues, leases annuities, personal services contracts are also very important to include.  It’s very important to note that the list I just provided is not an exclusive list of all the documents that must be provided in the Medicaid application process.

If you would like us to help you with your Medicaid application process, we would be honored to do so.  Please give us a call at Waller & Mitchell, 727-847-2288.

Video Summary

Using long-term care insurance and planning for incapacity.  Long-term care insurance, available through private salesmen or through union and employment sources can be an essential planning consideration in advance of incapacity.  There are three main types of coverage available in long-term care insurance – home healthcare insurance, assisted living care insurance and skilled nursing care insurance.  The cost of medically necessary skilled intermediate and custodial care nursing, home residency will be covered if policy considerations are met.  This may be crucial to affording care if you are not eligible for Medicaid as the average cost of skilled nursing care, currently in New Port Richey, Florida, is approximately $7,000.00 per month.

In-home care – the cost of a doctor prescribed home healthcare aide furnished by a home healthcare agency will be covered if policy conditions are met in the right circumstances.  This may be crucial to some, as without coverage, the average cost of a home healthcare aide in New Port Richey, Florida is approximately $100.00 per day.

Assisted living care insurance – the cost of assisted living care insurance are increasingly covered by modern policies.  Some policies are equating assisted living care coverage with home healthcare coverage for insurance policies and either one of them will be covered under the benefits of your policy if you have home healthcare insurance.  The average cost of the assisted living care facility for a monthly basis in New Port Richey, Florida currently is approximately $2,000.00 per month.

There are some considerations that you need to make prior to purchasing long-term care insurance.  The younger the purchaser, the less expensive the policy premium is going to be.  For the desired coverage, it is recommended that a person at age 75 would pay approximately $5,000.00 to $6,000.00 per year in premiums for long-term care insurance.  Additionally, another benefit is a tax deduction that you may make when you file your income taxes.  The tax deduction that you may make would need to be for an itemized tax return for long-term care insurance, but the premium must be at least or more than seven percent (7%) of your adjusted gross income.

Also, very few companies will write policies for people who are over the age of 82 years old.  To be very honest, most insurance companies won’t write them at all.  That’s why it’s very important to take these considerations into your estate planning when you’re at age 70 and older.  As you get older, as I stated it’s increasingly difficult to get this sort of insurance coverage.

Most important to consider in planning for long-term care insurance is the quality of your insurer.  Dealing with the fly-by-night insurance company may save you costs in the interim, but it will surely mean more grief when the time is come to collect the benefits that you crucially need at that time.  Most important to consider is the stability of the company, it’s management skills, it’s payment history, and the investor practices of the specific company.

These are the most important evaluations to consider with long-term care insurance.  If you have any questions or need assistance in involving incapacity of your loved one, please give me a call here at Waller and Mitchell at 727-847-2288.

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.

Video Summary

How does a married person qualify for Medicaid coverage for skilled nursing care?  Well the requirements for a married person are very similar to that of a single person.  First and foremost the applicant must be 65 years of age or older or must be a disabled adult.  The individual must be a citizen of the United States or a permanent resident.  You also must be a resident of the state of Florida but the residency requirement simply means that you must be in the state of Florida in a skilled nursing facility or in a care facility at the time the application is made.

You also must be medically needy and need skilled nursing care.  Well how is this determined, most people ask?  The Department of Children and Families has a special unit known as the Cares Unit that will come out to do a medical assessment after the application for Medicaid is received.  They will then determine whether or not the individual meets the criteria for the medical necessity portion that is required to receive Medicaid coverage for skilled nursing care.

There is also income and asset requirements similar to that of a single person.  The gross monthly income of the applicant cannot exceed $2,163.00 per month.  If the gross monthly income does exceed $2,163.00 per month, the good thing for a married couple, is that the applicant may defer a portion of their income to their spouse in order to qualify.  The combined total of both the applicant and the spouse cannot exceed $4,000.00 income per month.  If it does exceed $4,000.00 per month, we can set up a qualified income trust also known as a Miller Trust in order to qualify for eligibility to meet the income requirement.

There is also an asset limit for the applicant in a married situation.  In the married couple situation the individual cannot have more than $2,000.00 in countable assets.  However, the community spouse, also known as the non-institutionalized spouse, can maintain assets of up to $117,240.00.  And this obviously is the spouse that is at home.  Assets owned by either spouse must be pooled and the care giving or community spouse is entitled to certain exempt or non-available assets which include the personal residence.  Now again, the personal residence cannot have an equity value of more than $500,000.00.  They can also maintain a vehicle, one vehicle, any age, can be a luxury vehicle, and also a second additional vehicle which cannot be a luxury vehicle and must be seven years or older.

They also could maintain life insurance policies but the cash value or surrender value could not be greater than $2,500.00 for those life insurance policies.  And they can also maintain burial funds or an irrevocable, prepaid funeral contract.  The irrevocable prepaid funeral contract cannot be – excuse me.  It can be for any amount but the prepaid burial account cannot exceed $2,500.00 and this account can be used for pretty much anything associated with the burial expenses such as flying family members down from out of state, flower arrangements or anything that you may need in the process of a burial.

Also, the institutionalized spouse is allowed to keep personal needs allowance in the amount of $105.00 each month to pay for things such as toothpaste, hair care products, anything that may be necessary, toiletries for the institutionalized spouse.  And that has changed significantly as for many years it was $35.00 and in 2014 it did go up to $105.00 so people are very, very happy about that.

There is a lot of information regarding qualifications for married couples and I would love to give you more information.  Please contact our office if you have any further questions.  My phone number is 727-847-2288.