Nursing Home and Assisted Living Medicaid

The state of Florida implemented a long term care Medicaid program in 1970, which is a federal and state funded health insurance program, to help offset the financial burdens of those in need. There are many types of Medicaid benefits under this program, but the benefits we most frequently discuss with our clients are Medicaid benefits that help cover the long term care needs in an Assisted Living Facility (ALF) or Skilled Nursing Facility (SNF).

Assisted living Medicaid benefits fall under the Florida Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC), often referred to as a nursing home diversion program, or the Medwaiver program. This type of Medicaid provides assistance in-home, in the community or in an assisted living facility. The benefits vary depending on the needs and residence of the applicant. An applicant must join a waitlist for receipt of these benefits. To qualify for benefits under SMMC LTC you must be a legal Florida resident; be a minimum of 65 years of age or disabled; need assistance with two or more activities of daily living (or suffer from significant memory impairments) and; you must meet the financial requirements for Florida Medicaid.

Skilled Nursing Medicaid falls under the Institutional Care Program (ICP). The Institutional Care Program helps people in nursing facilities pay for the cost of their care. Unlike the SMMC LTC there is no waitlist for receiving assistance under ICP. If you are in a skilled nursing facility, the facility has a Medicaid bed available and you meet the eligibility requirements of the program, once your application is approved, ICP Medicaid dollars will be made available to cover the cost of your care. To qualify for benefits under the Institutional Care Program, like with the SMMC LTC program, you must be a legal Florida resident; be a minimum of 65 years of age or disabled and you must meet the financial requirements of for the program. The primary difference in qualifying between the two programs is the medical determination of the applicant’s level of care. To qualify for ICP benefits you must need twenty-four-hour skilled nursing assistance.

Once an individual determines what level of medical care they require and in what facility their needs will best be met, an Elder Law Attorney can help focus the applicant (or the applicant’s agent under a durable power of attorney) on meeting the financial requirements for the programs. The financial requirements for ICP and SMMC LTC are virtually identical but the strategies for seeking eligibility under each program may vary.

With assisted living Medicaid planning, the focus is typically on longer term goals. With the applicant on a waitlist, the timing of the application is unpredictable. The wait for SMMC LTC benefits can range from months to years. It is important that a detailed and practical discussion be had with an Elder Law Attorney on how to best meet the applicant’s financial needs during this time without jeopardizing future eligibility under the program.

With nursing home Medicaid planning, the focus is often on immediate transfers of assets. Generally, transfers of assets between spouses are permissible and will not affect eligibility. Transfers of assets to other individuals, if done incorrectly, could penalize the applicant and result in a determination of ineligibility for the Medicaid program. Kobi A. Finley, an Elder Law Attorney with Finley Law LLC, has advised hundreds of clients and processed hundreds of applications. She has the knowledge to advise you regarding permissible transfers and how to otherwise meet the eligibility requirements of either program. Call Finley Law LLC today to set an appointment to see how you or your loved one can qualify for Medicaid to help cover the costs of long term care 386-734-5959.