Florida’s Medicaid LTCMC (Long-Term Care Managed Care) plans can help cover associated costs with home health care, assisted living facilities, nursing care, medical equipment and supplies, and more for anyone who qualifies. How do you know if you’re eligible? There are two parts when it comes to eligibility, and today we will discuss them.
Part 1 of Qualifying for Florida’s Medicaid LTCMC Plans: Needing Nursing Home Level Care
Anyone who qualifies for this program requires a nursing home level of care or close to it. What this means is that you have to show proof that your condition is severe enough for you to be in a nursing home or would need to be in a nursing home if you weren’t receiving supportive long-term care services. Florida’s long-term applicant screening program is Comprehensive Assessment and Review for Long-Term Care Services (CARES). The Department of Elder Affairs conducts these CARES assessments. Someone will interview you and ask you many questions about your mobility, what kind of help you need, and your medical conditions. This assessment will prove that you need a nursing home level of care. At Millman Law Group we help guide individuals through these assessments so that they can receive services as quickly as possible.
Once you qualify for an LTCMC plan and enroll in one, you will have to prove that your chosen plan is medically necessary. LTCMC plans will not cover what isn’t medically necessary. What does “medically necessary” mean? It means that the services offered are:
- necessary to protect life, prevent severe illnesses, or reduce severe pain
- consistent with symptoms of the disease or injury under treatment and professional medical standards
- safely furnished with the level of service to which no equally effective or less costly treatment plan in the state is available
- not provided in a manner solely for the convenience of the recipient, caretaker, or provider
Part 2: Financial Eligibility
Even if you are 18 years of age or older and meet the nursing home level of care, there are still financial restrictions. You can only qualify for LTCMC plans if you meet the income and resource limits. For this reason, Medicaid planning, including qualified income trusts, personal caregiver agreements, pooled trust, special needs trusts, etc. are often necessary for disabled persons to receive government benefits. Here’s are a few things to know about the complex financial eligibility for LTCMC plans:
- Your gross income cannot exceed $2,382 a month. However, if your income does exceed this number we can help you qualify for benefits. There is no such thing as having “too much income” to qualify for Medicaid LTCMC services.
- Countable assets for a person cannot exceed $2,000. Countable assets do not include certain assets such as a primary homestead, retirement accounts in payout, rental properties. etc. We can go over all of this with you during our consultation.
- A spouse who is NOT in long-term care can have up to $130,380 in countable assets under certain spousal allowance rules. In fact, a spouse can even have an unlimited amount of assets under other rules deemed ‘spousal refusal’ and the transfer between spouses does not count as a gift subject to a 5-year look-back rule – which can make eligibility even sooner than expected!
So, how does Millman Law Group factor into all of this? We offer Medicaid planning services to ensure that your income and countable assets won’t make you ineligible to receive the long-term care you need without depleting your entire estate!
MILLMAN LAW GROUP PLLC MAKES A BIG DIFFERENCE TO AN UNDERSERVED COMMUNITY
Millman Law Group, PLLC is rare because it’s one of the only law firms that offer life planning in South Florida. From life care planning to the preparation of detailed estate plans, Millman Law Group has committed to serving Floridian elderly communities in Boca Raton, Palm Beach County, Ocean Ridge, Hillsboro Beach, and many other areas since 2018. Our dedicated team also specializes in special needs trusts and catering to any age demographic because we know for certain it’s never too early to start preparing you and your family for your future. For the latest news in estate planning and elder care law, follow us on Facebook, Twitter, Linked In, and Pinterest. You can also contact us at 561-463-6480.