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What Families Need to Know About Using Medicaid to Pay for Long-Term Care

If your loved one needs constant care, you may be faced with the difficult decision to place them in a nursing home. In some cases, it isn’t the emotional reaction that families fear the most—it’s finding a way to pay for the significant costs of long-term nursing care.

Could My Loved One Get Nursing Home Care Through Medicaid?

Elderly Woman and Nurse in a Nursing Home FacilityMedicaid was created to ensure that people who have very few resources can still get the late-in-life care they need. In Florida, Medicaid can be used to pay for an elderly relative’s nursing home, assisted living facility, or in-home nursing care. Medicaid pays a fixed daily rate to cover costs such as a patient’s room, meals, staff care, and medical supplies, possibly for the remainder of their life.

However, Medicaid will only pay for nursing home care if your loved one meets the program’s eligibility requirements, including:

  • Needing a nursing home level of care. Each state has a different definition of what a nursing home level of care actually is. In general, nursing home care is required if a loved one’s medical condition, mental state, physical restrictions, or other vulnerability makes them a danger to themselves if they are left unsupervised. As part of your application, your loved one will be assessed by a doctor and be granted (or denied) recognition as a candidate for long-term care.
  • Having minimal income. Applicants’ incomes have to be below a certain level in order to meet Medicaid eligibility. Residents are allowed to keep a small allowance of their income for personal needs (such as entertainment, snacks, and personal products), but must stay under the income limit. For example, the 2022 Florida income limit is $2,523 per month with a personal needs allowance of $130 per month. If income is over the limit, a qualified income trust must be used in order to gain Medicaid eligibility.
  • Basic Financial Aspects to Get Medicaid:
    • For a single person, the Medicaid applicant is only able to have $2,000 in countable assets
    • For a married couple, the couple is allowed to have a total of around $140,000 in countable assets to allow one spouse onto Medicaid.
    • A good elder law attorney can help protect assets as a part of the Medicaid application.
    • Countable assets generally include bank accounts, stocks, bonds, etc., but do not include the applicant's homestead. 
    • We have more on financial eligibility on this webpage.
  • Contributions to long-term care. Keep in mind that the income threshold is just to qualify for long-term care Medicaid. If your family member meets the income requirement, they will still have to give up nearly all of that income to Medicaid as partial payment for their care. For example, an applicant who makes $2,000 per month is eligible, but they will have to pay $1,870 of their income to the nursing home (known as the Patient's Responsibility). If income is over the income limit, then a qualified income trust can/must be created in order for the applicant to get long-term care Medicaid.
  • Owning minimal assets. Medicaid is available to people who have few resources that could be used to cover the costs of care. However, applicants do not have to give away all of their assets to qualify—in fact, this can work against them. Medicaid has a 5-year look-back period to determine whether any assets have been transferred for less than fair market value. If an applicant retitles his home property in his son’s name it may result in a penalty period of Medicaid ineligibility. A good elder law attorney (like us!) can advise on how to protect assets and can provide proper spend down planning, even when the elder is already in the nursing home.
  • Nothing is Easy. When your loved one needs long-term care, nothing is easy. Friends, family and even people working in healthcare think they know good advice. Here are some common Florida Medicaid myths you should read about if you are helping yourself or your loved one.

Even if you meet these requirements, you may still have trouble securing a nursing home residency. For one thing, not all nursing homes and assisted living facilities accept Medicaid payments (The American Council on Aging offers a search tool to find facilities near you that accept Medicaid). Medicaid also counts any gifts and property transfers made up to five years before the date of application, which could delay your eligibility and force you to pay for immediate costs of care out of your own pocket.

It’s possible to secure the care you or a loved one needs without sacrificing everything you have built over your lifetime. By starting the Medicaid planning process early, an experienced elder law attorney can redirect income and assets over the Medicaid limit, keeping your heirs’ inheritances safe while you receive long-term care.

What About Assisted Living Medicaid?

Medicaid pays for both the nursing home and assisted living/in-home care but the rules differ in subtle but important ways. If your elder wants Medicaid for the assisted living facility, we have more on Assisted Living Medicaid in Florida to assist you.

Need Help with Your Elder?

We charge $200 to consult with our elder law attorney where we will:

  • Evaluate your elder's situation
  • Translate the issues you are having - there is a great deal of bad information you will receive in helping your elder - we cut through the BS!
  • Review the estate plan/durable power of attorney (very, very important!)
  • Discuss how Medicaid may help your elder's situation
  • In the event you need further help, we will quote a fee for any services

We can help your elder no matter where you live!  We have done thousands of Medicaid applications helping families in difficult situations and we are glad to help you.

 

D. Rep DeLoach III
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Estate Planning and Board Certified Elder Law Attorney