Medicaid Programs

Medicaid is a joint federal and state program to provide health care for people whose assets and income fall below certain levels. Medicaid is different from Medicare, and it is important to keep these two programs separate. Federal law defines the rules for the Medicaid and Medicare programs. The federal government implements and manages Medicare. The individual states implement and manage Medicaid.

Like all states, Florida has several Medicaid programs that apply to different people with different needs and circumstances. Florida has not “expanded Medicaid” under the Affordable Care Act (“Obamacare”). Therefore, people with incomes below 133% of the federal poverty level are not automatically eligible for Medicaid in Florida. (The federal poverty level varies based on the size of your family).

Medicaid Nursing Home Benefits

Below is a list of the types of Medicaid available in Florida:

Medicaid for people who are disabled and receiving Supplemental Security Income (SSI) from Social Security

In Florida, people who are awarded SSI benefits automatically qualify for Medicaid. Both SSI and Medicaid have strict limits for both income and assets – people whose income or assets exceed these limits do not qualify for SSI and/or Medicaid or risk losing their SSI and/or Medicaid benefits.

Medicaid for people over age 65 who reside in a nursing home. This is often called “nursing home Medicaid” or “ICP (institutional care program) Medicaid” and is the most common source of payment for nursing home care.

In Florida, Medicaid will pay the full cost of nursing home care for people over age 65, who require the type of care or assistance provided in a nursing home, and who meet the strict income and asset limits for the program.

As of July 2018, Florida residents over age 65, who require nursing home care, whose gross income is less than $2,250 per month, and whose assets are less than $2,000 automatically qualify for “nursing home Medicaid.”

If you or a loved one do not automatically qualify for nursing home Medicaid, don’t give up. Attorney Cathy Blackburn can often help seniors restructure their income and assets in order to qualify for benefits using strategies that are entirely legal and approved by Florida Medicaid.

The most beneficial time to consult an attorney about nursing home Medicaid is when the senior is transferred to a “rehab” facility, nursing home, or “skilled nursing facility.”It is easier and less stressful to analyze resources, restructure income and/or assets, and plan for Medicaid benefits before Medicare benefits have been exhausted. Even if the “most beneficial time” has passed, Cathy can help restructure assets and income, and qualify for benefits.

Medicaid for people over age 65 who require assistance and live in their own home or assisted living. This is often called the “Statewide Medicaid Managed Care Long-term Care Program” (SMMC LTC) or the “Medicaid Waiver Program.”

In Florida, Medicaid will pay a portion of the cost of assistance at home or an assisted living facility for people over age 65, who require substantial assistance with activities of daily living, and who meet the strict income and asset limits for the program.
Benefits under this program are limited and there is currently a waiting list to receive these benefits.

The income and asset limits for this program are the same as for nursing home Medicaid: As of July 2018, gross income must be less than $2,250 per month, and assets must be less than $2,000.

If you or a loved one do not automatically qualify for home-based Medicaid, don’t give up. Attorney Cathy Blackburn can often help seniors navigate the waiting list and restructure their income and assets in order to qualify for benefits using strategies that are entirely legal and approved by Florida Medicaid.

As with nursing home Medicaid, the most beneficial time to consult an attorney about home-based Medicaid is when the senior is transferred to a “rehab” facility, nursing home, or “skilled nursing facility.” It is easier and less stressful to analyze resources, restructure income and/or assets, and plan for Medicaid benefits before Medicare benefits have been exhausted. Even if the “most beneficial time” has passed, Cathy can often help restructure assets and income, and qualify for benefits.

Other types of Medicaid

Florida provides some Medicaid benefits for people with limited income and assets who: cannot afford their Medicare Part B premiums; cannot afford their Medicare co-pays and deductibles; require Hospice care; and/or suffered an exceptionally expensive illness or injury. These kinds of Medicaid have very specific criteria and depend on the person’s individual circumstances. The Florida Department of Children and Families works with partner agencies to answer questions and assist Florida residents to apply for benefits. Visit www.myflfamilies.com to find out more about these programs or find a DCF or partner agency office.