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Medicaid

Assistance in Determining Eligibility

Medicaid Attorney Daytona Beach

Laws related to nursing home Medicaid change frequently, on the federal, state, and administrative agency levels. Understanding Medicaid and how such state and federal assistance works can be a daunting task for many families, without professional help, protecting one’s interest can be difficult.
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At Upchurch Law, we work daily as a liaison between clients and the Florida Department of Children and Families in order to assist clients in obtaining Medicaid benefits when a client or their loved one is in need of assisted living facility or nursing home care. We assist clients with every step of the Medicaid application process, including the completion of the Medicaid application and the allocation of their assets so that they will not adversely affect their Medicaid eligibility.

If you are private or self-paying for either yourself or for a loved one, you should contact our office immediately to find out if Medicaid can reduce or eliminate this financial burden.

About Medicaid

Medicaid is a dual federal and state program that aids older and/or disabled persons to obtain government assistance for a variety of personal needs.

In Florida, Medicaid eligibility for long-term nursing home care is based on the assets and income of the Medicaid applicant, as well as the assets and income of the Medicaid applicant’s spouse.

To qualify for Medicaid, you need to meet three categories of requirements.

Categorical Requirements

The Medicaid applicant must be a citizen or resident alien of the U.S., and must have medical needs requiring nursing home placement, or must be physically or cognitively impaired to the degree that nursing home placement is required.

Income Requirements

The Medicaid applicant’s gross monthly income cannot exceed $2094.00 (effective Jan. 1, 2012). The Medicaid applicant’s well spouse or “community spouse” has no limit on their gross monthly income.

Asset Requirements

The Medicaid applicant cannot own countable assets in excess of $2,000.00 in addition to exempt and countable assets. The Medicaid applicant’s well spouse may retain up to $113,640.00 (effective Jan. 1, 2012) in assets plus exempt, non-available and income-producing assets.Contact Florida Medicaid Attorney Thomas Upchurch for Consultation.

If you have any questions about the Medicaid system, we urge you to contact us at (386) 320-6169 to schedule a telephone consultation.

You can also email us at tupchurch@upchurchlaw.com and we’ll gladly respond to your inquiry.

Home and Hospital visits are available.


Additional Information

Asset Protection Techniques

The following strategies from a Florida Medicaid attorney are just some of the various options available to help protect an individual’s assets when confronted with the high costs associated with long term care. The amount various plans can potentially preserve vary on a case by case basis.

Personal Service Contracts

Through a personal service contract that a Florida Medicaid attorney can explain, the institutionalized spouse may hire a family member or designated individual to perform certain tasks on an “as needed” basis. This essentially compensates and reimburses family members for all the hard work they take on in taking care of their institutionalized loved ones.

Annuities

This planning technique offered by a Florida Medicaid attorney is most viable for a community spouse who is over the community spouse asset cap of $113,640. Such an annuity must be irrevocable, actuarially sound and designate the State of Florida as the 1st beneficiary. Such an annuity can supplement the community spouse’s monthly income and provide financial security going forward.

Irrevocable Trusts

Irrevocable trusts are most commonly used as a pre-planning vehicle. The advantages of implementing a plan using an irrevocable trust is the settler can continue to derive income from their assets. The main drawback to using an irrevocable trust is the settler gives up the right to access the principal.

Gifting

Gifting is the giving of assets to a designated individual. A Florida Medicaid attorney wants potential medicaid applicants should be aware of the potential consequences a gift can have on their eligibility for Medicaid. Gifts are considered an uncompensated transfer and if made during the look back period will result in a penalty period.
Spend Down Method

Certain assets are exempt and therefore permitted by Medicaid. It is important to know what these assets are and how to take advantage of them. Taking advantage of these exempt assets is the first recommendation when crafting a suitable long term care plan.

Exempt Assets

Exempt assets may be owned by either the community spouse or the institutionalized spouse and are not calculated when determining an applicant’s available resources. The following are some of the exempt assets not counted when determining Medicaid eligibility for Florida’s Institutionalized Care Program.

Homestead

As long as the institutionalized spouse has intent to return home, the applicant’s residence is not calculated as long as they have less than $500,000 in equity in the home. The applicant’s ability to return home is not evaluated. If a spouse, minor child or disabled child resides in the house, the applicant may have unlimited equity in the home.

Life Insurance

Whole life policies with a face value of $2,500 or less are exempt. The Department of Children and Families will review the cash surrender value and any cash surrender value in excess of $2,500 will be counted towards the applicant’s permissible resource allowance. Two motor vehicles are exempt. One regardless of age or value and the second one must be over seven years old.

Burial Plan

Both the Medicaid applicant and their spouse may have an irrevocable burial, funeral or cremation policy regardless of the amount.

Burial Fund

If there is no life insurance policy, the applicant and their spouse may have a designated $2,500 burial fund.

Personal Property

One wedding band and one engagement ring are exempt for both the Medicaid applicant and their spouse. Other personal property is also exempt as long as it isn’t valuable art or jewelry.

Medicaid FAQs

Answering Frequently Asked Questions about Florida Medicaid

We know the language and intricacies of the Florida Medicaid system can be confusing, so we’re answering some of the most common questions we hear in plain English.

A: The limit on assets a Medicaid recipient may own is low, and even the assets the recipient’s healthy spouse can keep are limited. With advance planning, it’s possible to preserve access to assistance with medical care without draining the family’s resources. But when the need for Medicaid assistance arises, it will be too late to protect many assets. In addition, gifts and certain other transfers made during the “look back” period may trigger penalties. The earlier you begin to plan, the better your options for preserving your family’s resources.
A: To prevent people from circumventing the Medicaid asset limits by transferring property to others, the state examines transfers made during the five years prior to the Medicaid application. This is known as the “look back” period. Gifts or transfers for less than fair market value during that five-year period can trigger penalties when determining eligibility.
A: Medicare is a federal program funded through payroll withholding and self-employment taxes. Working people “pay in” while they’re earning money and they and their dependents are entitled to benefits when they reach the designated retirement age, or become disabled. However, Medicare covers only brief stays in skilled nursing facilities, and imposes strict requirements to cover even short stays. Medicaid, on the other hand, is a state-operated system for providing medical care to those unable to afford it, providing many people who could not otherwise afford long-term care the help they need.
A: While it is possible to apply for Medicaid while in a nursing home, and sometimes an emergency medical situation makes this approach necessary, it’s not the best approach for most applicants. Medicaid approval can take months, and a long-term care facility may be unwilling to take on a resident without knowing whether he or she will be approved. If immediate care is required, an alternative guarantee of payment may be required.
A: According to the Kaiser Foundation, about 65% of nursing home residents nationwide are dependent on Medicaid. Although that figure is a bit lower in Florida, well over half of residents in Florida long-term care facilities rely on Medicaid benefits. With the average cost of a semi-private room in a Florida nursing home hovering just below $8,000 a month, most families simply can’t absorb the cost.
A: Benefits Medicaid pays on behalf of a person aged 55 or older create a debt to the state. While many Medicaid recipients have no means of repaying that debt, the state will submit a claim against the recipient’s estate when he or she passes away. While there are some exceptions, such as when there is a surviving spouse or dependent minor child, the state will typically pursue this recovery, and the cost can be enormous.
A: Medicaid Estate Recovery applies only to the recipient’s estate. That means that with advance planning, it is possible to protect many assets from eventual recovery. The best means of protecting assets may vary depending on your circumstances, amount and type of assets, and other factors. Talking with an estate lawyer experienced in Medicaid planning as far in advance as possible will maximize your opportunities for preserving assets.

Our law firm represents clients throughout Central and North Florida including Volusia, Flagler, St. Johns, Duval, Putnam, Lake, Seminole and Orange counties. Cities include: Daytona Beach, Port Orange, Deland, Ormond Beach, Palm Coast, Jacksonville, Orlando, Saint Augustine and New Smyrna Beach. If you have any questions about the Medicaid system, we urge you to contact us at (386) 320-6169 to schedule a  telephone consultation. In the alternative, you can email us at tupchurch@upchurchlaw.com and we’ll gladly respond to your inquiry. Home and Hospital visits are also available.