Given the limitations on what a person may own to successfully apply for Medicaid, families often conclude that mom and dad will have to forfeit everything they own in order to qualify (to get mom or dad in a nursing home, or otherwise get the care mom or dad will need). When I first heard about the “spend down” tactic as a way to qualify for Medicaid, I was horrified to realize that we as attorneys, in certain circumstances, are actually having to advise people to spend or transfer what they have in order to get into a nursing home. Regardless, with proper planning, this result can be avoided.
This will be the first of several installments to provide general guidance on how to protect your property and funds while qualifying for Medicaid.
Before discussing the asset restrictions, some basics about Medicaid need to be discussed, such as: What is Medicaid? The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care.” (America’s Health Insurance Plans (HIAA), pg. 232). Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States. When I first read that definition, I was a bit put off because it sounds like a program for people who are really poor. But, as with many issues in life, it’s all relative – you have to have a standard to measure the need for Medicaid benefits. That standard can be understood with one number: $8,000.00 per month. That is the average cost of nursing home care in the State of Florida. Obviously, many people will have income and resources that are “insufficient” to pay for health care by that standard. Without long-term care insurance or independent wealth, Medicaid will be needed to pay for long-term care, such as nursing home or assisted living arrangements.
Before you can even get to the property or financial requirements imposed by the Florida Institutional Care Program (ICP) Medicaid, certain preliminary requirements must be met, including:
- Age: Must be 65 or older, or otherwise blind or disabled;
- Citizenship: Must be a U.S. citizen or a qualified noncitizen;
- Resident: Must be a resident of Florida;
- Medical Eligibility: The applicant must have medical needs that require a type and level of care that is provided by a nursing home (a person who only needs assisted living will not qualify for a nursing home).
In the next installment, we’ll begin a discussion of resource eligibility, including asset limits that must be met in order to qualify for Medicaid.