Medicaid Planning

The Nursing Home Program is an entitlement program, so it is always funded.  However, the Home Program and the Assisted Living Program are not entitlement programs.

There is currently a waiting list for the two (2) lower Long-Term Care Medicaid Programs.  There is a statewide waiting list of over 25,000 people. We do not know when additional funding will be provided by the Florida Legislature to the Home and Assisted Living Facility Programs.  The waiting list for the Home and Assisted Living Programs are triaged based on need.

There are two (2) priority scores provided given at the time of an interview for Medicaid’s waiting list:  a medical score; and a gaps in coverage for the activities of daily living score.

The sole manner in which to avoid Medicaid’s waiting list for the Home and Assisted Living Program is to be in a nursing home for at least 60 days on Medicaid (not Medicare), and then participate in Medicaid’s “Transition Down” Program.

Medicaid just increased the Personal Needs Allowance from $35 a month for the nursing home Program to $105 a month.

Patient accounts at facilities count as part of an individual’s $2,000 asset limit for Medicaid’s Long-Term Care Programs.

Exempt Assets for Medicaid purposes consist of assets such as a Florida homestead home for a single person up to $543,000 equity, for a couple homestead equity is unlimited; pre-paid irrevocable burial; any one vehicle is exempt as well as vehicles over seven (7) years old if not collector’s car; a $2,500 burial fund in addition to the pre-paid burial; term life insurance; life insurance with an aggregate face value of $2,500 per person; and $2,000 of countable assets for the institutionalized person and $117,240 of additional assets for their spouse (as of 10/2014).

There is no patient responsibility amount when receiving Long-Term Care Medicaid benefits from the Home Program.

The VA Aid and Attendance Program does not cover nursing home care; the benefit drops down to $90 if you are in a nursing home.

Medicaid and the VA Aid and Attendance Programs have  completely different sets of rules from each other.

An individual can receive both Medicaid benefits and VA Aid and Attendance benefits while they are at their home or in an Assisted Living Facility.

The VA is currently 11-13 months behind in approving applications, but the applications pay benefits retroactively and there are private companies that commence benefits immediately and then collect from the VA when it is eventually paid out.

Medicaid switched to a Managed Care Delivery System in August 2013.

Medicaid revamped its Long-Term Care Programs in August 2013 so that all three (3) Long-Term Care Programs are out-sourced by the State to private providers.  Brevard County’s District (District 7) has four (4) Providers that administer Medicaid’s Long-Term Care Programs in our area.

The Community Spouse’s (healthy spouse) income is unlimited by Medicaid.

There is unlimited spending by the person applying for Medicaid for their bills or repairs/improvements, etc. to their property.

Medicaid has a five (5) year look-back period for uncompensated transfers (gifts).

The VA Aid and Attendance Program does not have any look-back period currently.

All VA applications are processed initially in Philadelphia.

All Long-Term Care Medicaid applications are processed locally.

If a Medicaid applicant has gross monthly income above Medicaid’s income cap (currently $2,163), they will need a Qualified Income Only Trust which can be entered into by a spouse, or an Agent under a Durable Power of Attorney which specifically states the right of the Agent to “create and fund a trust”.