ELDER LAW AND MEDICAID

Medicaid Institutional Care Program (ICP), usually just called Medicaid, is a joint federal and state program that pays for the care of the elderly in a nursing facility. In Florida, the Medicaid program is administered by the Department of Children and Families (DCF).

Three Basic Criteria to Qualify for ICP Medicaid

The first two are not often a problem:

Level of Care: Applicant must need nursing home care. The level of care is verified by the Department of Elder Affairs (DOEA).

Income Cap: While there is an income cap ($2,199.00 for 2015), applicants with higher income may execute a Qualified Income Trust, resulting in eligibility.

Most Medicaid planning revolves around the third criteria, namely, asset limits:

If you need to discuss the asset limits, and all the items that aren't considered assets for purposes of eligibility, please contact us. In the meanwhile, be very cautious about any suggestions to transfer the home, or giving away assets, or hiding information from DCF (this is illegal, and people should know that the DCF computers are tied in to the IRS and other information sources). Assets can be preserved without the need for actual impoverishment, and without breaking the law. For a single applicant, the asset limit is $2,000 ($5000 if monthly income is less than $871). The homestead (up to $552,000) is exempt. A car is exempt. An irrevocable burial contract is exempt. Certain heavily regulated real estate investments are exempt as to the principal, but not the income generated. In some cases, a "personal services contract" can be implemented, where a binding promise is made to supervise the care of the elder for the rest of his or her life, in exchange for an upfront payment. Be very cautious about transfers (gifts) to family or others (the rules are favorable for transfers to a spouse or disabled child). For most transfers, there is a "look back" period of 60 months, which does not start to run until a Medicaid application is filed.

Medicare's coverage of nursing home care is limited. Medicare covers up to 100 days of "skilled nursing care" per illness, but Medicare recipients are often discharged from a nursing home before they are ready.

In order for a nursing home stay to be covered by Medicare, you must enter a Medicare-approved "skilled nursing facility" or nursing home within 30 days of a hospital stay that lasted at least three days. The care in the nursing home must be for the same condition as the hospital stay. In addition, you must need "skilled care." This means a physician must order the treatment and the treatment must be provided daily by a registered nurse, physical therapist, or licensed practical nurse. Finally, Medicare only covers "acute" care as opposed to custodial care. This means it covers care only for people who are likely to recover from their conditions, not care for people who need ongoing help with performing everyday activities, such as bathing or dressing. If you need skilled nursing care to maintain your status (or to slow deterioration), then the care should be provided and is covered by Medicare. In addition, if there is a potential for adverse interactions among multiple treatments it may require that a skilled nurse monitor the patient's care and status. In such cases, Medicare should continue to provide coverage.

Once you are in a facility, Medicare will cover the cost of a semi-private room, meals, skilled nursing and rehabilitative services, and medically necessary supplies. Medicare covers 100 percent of the costs for the first 20 days. Beginning on day 21 of the nursing home stay, there is a co-payment ($157.50 a day in 2015). This copayment may be covered by a Medigap policy. After 100 days are up, Medicare stops paying (though it usually ends much earlier).

If you are in a nursing home and the nursing home believes that Medicare will no longer cover you, it must give you a written notice of non-coverage. The nursing home may discharge the following day. There are administrative appeals that can be filed to slow this process; a Quality Improvement Organization (QIO) and then an "Administrative Law Judge" (ALJ) or Hearings Examiner.

As a way to stay in the home, and thus avoid the need for Medicaid to cover a facility, consider a Reverse Mortgage:

Reverse Mortgages (.pdf)

Reverse Mortgages could help another way  - if there was already a mortgage on the homestead, but no funds to pay the mortgage once the Senior has been admitted to the nursing home; a Reverse Mortgage is a way to pay off the existing mortgage and defer payments on the new loan until the death of the Senior, but that's problematic because once the Senior no longer lives at the home, the Reverse Mortgage could be called due by the lender.

 

florida

Russell R. Winer, Attorney-at-Law

520 4th Street North, Suite 102
St Petersburg FL 33701
727 821-4000
Toll Free Number: 877-591-6800
806 N Armenia Ave
Tampa, FL 33609
Phone: (813) 933-5700
Fax Toll Free: (866) 774-2476
E-mail: attorney@inherit-florida.com