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A Guide to Using Medicaid for Senior Care in Florida

senior care with medicaid
Figuring out how to pay for care as you age is not easy. Paying for long-term senior care is particularly costly. Insurance carriers may not cover the care or may have some kind of cap on the amount that can be paid towards those costs. Many seniors turn to Medicaid when faced with paying for senior living. It covers the cost of care over multiple years when other insurers may not. This article covers what seniors and their families need to know about obtaining coverage for senior care in Florida.

Exemption Limits

To receive benefits, applicants in the state of Florida must meet certain criteria. The principle one that most seniors need to know about is called asset exemption limitations. It is important to note that if an applicant has more assets than are listed below, selling or giving these items away will not exempt them even if it is for long-term care purposes.

There is a five-year look back rule which means that if it was owned in the past five years, it is considered income. Under this criteria, certain assets are exempt up to a limit. They are:

  • Cash – Less than $2000 if single. If spouses both require nursing home care, that exemption is raised to $3000.
  • Property – One house up to $560,000 in value is exempt. The beneficiary must be planning to return, or a spouse, child under the age of 21, or disabled person must live there. If the exempted property is sold, the money from that sale will be considered income. A senior will lose their benefits until that money is spent down to the qualifying level.
  • A car of unspecified value.
  • Irrevocable burial insurance of unspecified value.
  • Personal items such as furniture, jewelry, clothing, and other non-saleable items are not factored into the exemption.

A spouse who isn’t in an institution, also known as a community spouse can keep a maximum of $120,000 or half of their significant other’s assets.

Dealing with Application Mistakes

Applying for coverage and navigating the system without expertise can be difficult. There are some common mistakes that can occur during the application process that seniors should be aware of as they go through the process.

The process of applying for benefits takes planning for getting senior care. A very common mistake is for someone to apply too early. As shown in the exemption section, certain conditions have to be met before approval is possible.

Here are some general guidelines for addressing application mistakes:

  • Misinformation – Many people assume that they have to be impoverished in order to receive benefits. This is why individuals have sold or given away money or other assets in the past. It is no longer a wise approach nor is it completely necessary. Consulting an expert can go a long way.
  • All Options – Consider all assets before applying for coverage to ensure that you have looked into all the options. There may be other opportunities available that may serve as a way to get the care or support needed.
  • Gifting – Many people assume that they can transfer a certain number of assets to others without consequence. But this isn’t true. Doing so may disqualify you from benefits. Consult a professional before gifting any assets.
  • Hiding Assets – Hiding assets to get approved for coverage is considered fraud and will delay or disqualify beneficiaries from receiving coverage. With proper planning, assets can be protected without an individual being impoverished.

Receiving Guidance

Going through the process of obtaining resources for care is complicated. The majority of people cannot navigate it alone. Luckily, there are many resources available to seniors in Florida intended to help you and your loved ones get the information and benefits that are needed.

SHINE – SHINE stands for serving the health insurance needs of elders. It is free program staffed by volunteers and offered by the Florida Department of Elder Care Service. SHINE volunteers are specifically-trained to help seniors with government and private insurance plans. It is a good place to start in getting help with the application and planning processes. They offer free counseling for beneficiaries, caregivers, and loved ones with regard to insurance.

Applying for benefits is just the beginning. Longer term planning beyond insurance approval is something that all seniors are encouraged to consider. An elder care lawyer can advise whether a power of attorney may be appropriate or when an asset transfer may need to happen.

Making the transition to senior living is a complex process with all of the options there are to consider. By providing insight into some of these options and resources, the decision to get care will be made easier.