Florida Medicaid offers number of specific programs to help the needy. In the elder law world, we are most frequently dealing with Medicaid to help pay for an elder's long-term care, whether it is in a nursing home, assisted living facility (ALF) or at home. These programs for the elderly are generally grouped together under the Statewide Medicaid Managed Care (SMMC) Long-Term Care Program. Accessing this program can be very difficult for a number of reasons.
The financial requirements for accessing Florida Medicaid are the same, whether the elder needs care in the nursing home, assisted living or is trying to stay at home. Accessing long-term care Medicaid can be dependent, however, on where the elder is located at the time of the application. If the elder is in the nursing home and is eligible financially, the elder will be accepted onto the Medicaid program. If the elder is in the assisted living facility or at home, there is a wait list to access this program, regardless of the finances. The wait list can take years to get through. The list to access Medicaid is based on helping the most frail and needy first. Thus, moving the elder into assisted living and then applying for Medicaid may not be a good option. There is, however, a "back door" to getting Medicaid benefits to help with assisted living or in-home care.
Medicaid Yes/Medicaid No
For clarification, Medicaid in the nursing home is an entitlement provided by Florida and the federal government. If a Florida resident is in a nursing home, the nursing home has a Medicaid bed available, and the applicant is eligible for Medicaid financially (i.e., income and assets are below the applicable limit), the applicant will receive Medicaid. The application process can be difficult even under simple circumstances, but the government will assure that the applicant will have a place to stay in the nursing home.
Medicaid does not, however, assure that an applicant will receive Medicaid benefits while they are at home or in the assisted living facility. Put simply, the state only guarantees Medicaid for a nursing home applicant, not an applicant for assisted living or in-home care. This leaves a lengthy waitlist for those applying for assisted living or in-home Medicaid benefits.
Bypassing the Assisted Living Waitlist
The best way to by-pass the wait list to get Medicaid benefits for the ALF is through the 60 day wait period when an elder is already in a nursing home. If the elder is already in the nursing home, we often take advantage of this opportunity to get Medicaid, then transition the elder to the ALF with Medicaid's assistance. Once the elder receives Medicaid and has been in the nursing home 60 days, the elder will be able to leave the nursing home and go home or to assisted living with Medicaid. We have some good information on questions to ask when your elder enters the nursing home. Veteran's benefits may also assist the elder and the surviving spouse of a war time veteran.
Monetary Benefits for Assisted Living Medicaid
Medicaid for assisted living or in home benefits has its limitations. This Medicaid program does not pay for all of the assisted living facility's cost, for instance, nor does it pay for 24/7 in-home care. In Florida, Medicaid will generally help with assisted living costs by reducing the monthly rent by $1,100-$1,200/month. This means that the elder is responsible for costs above this. If the elder has low income, for instance, the family may need to assist with assisted living costs. Our law firm could help protect assets above the bare minimum, which can happen even when the elder is already in the nursing home.
Example of Accessing Medicaid for Assisted Living
Mom, age 91, was living at home with advancing dementia. Mom falls and breaks a hip, going to the hospital and then to the skilled nursing facility to receive rehabilitation. While in the nursing home, the family decides that the elder should not go home due to safety reasons. The family hires an elder law attorney to assist with a Medicaid application. After 30 days of receiving rehabilitation, the elder's Medicare benefits stop paying for rehabilitation. With the attorney's Medicaid application in the works, the elder will stay in the nursing home (skilled nursing facility) until the Medicaid application is approved. After 60 days and the Medicaid approval, the elder will leave the nursing home and go to an assisted living facility with assistance from Medicaid.
VA Benefits can be Helpful
If your elder needs care in an assisted living facility, many often overlook VA benefits, which can provide even more money than Medicaid. We have more information VA Pension and Assisted Living benefits.
Hiring an Elder Law Attorney can be Vital
Even if the elder's income or assets are below the bare minimum, an elder law attorney can assist the elder and the family in making the correct decisions. We know the ways to access Medicaid quickly, which will help the elder leave the nursing home faster and get to the assisted living facility. Relying upon the nursing home to do the Medicaid application is not always the best idea due to the many complexities. If the elder has income or assets above the policy limits, an elder law attorney can be vital to legally protecting assets, reducing income, and more. Our law firm can help provide placement assistance, care coordination, medical advocacy and more with our life care planning practice. We also have super fast Medicaid applications as part of our procedures.
Help When You Need It
If your loved one needs long-term care, please do not hesitate to contact us for assistance. We offer a free initial consultation to make sure we are the best fit for you. We also offer free monthly seminars on Medicaid and asset protection planning. You may also want to read about the 7 lies your friends will tell you about Medicaid and elder law in Florida.