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.