Florida Medicaid Qualifications

Florida Medicaid Qualifications-Income Cap

Florida Medicaid Qualifications requirements include an asset test, an income test and a level of care test.

This article focuses on the Income cap, which is really an arbitrary rule which, with appropriate legal help, is easily remedied. As of January 1, 2019 the income cap is $2,313 in order to meet Florida Medicaid qualifications.  If a potential applicant for  Medicaid’s income exceeds $2,313 he or she will be deemed ineligible, unless the income is first placed in a qualifying trust, either a pooled trust or a qualified income trust established under Federal Law.

A qualified income trust is a fairly easy solution to an income cap problem in order to meet Florida Medicaid Qualifications.

The applicant, his or her spouse, an agent under power of attorney or a legal guardian (with the permission of the court) can establish a qualified income trust.  After establishment, the portion of the income over the income cap plus a little more (to prevent a slight miscalculation from become an eligibility problem) is transferred to the income trust.  It is then transferred to the nursing home for the payment of the patient responsibility.  The trust must provide that the state of Florida is the beneficiary of the trust, should any assets remain in the trust upon the death of the applicant. The only payments that may be made from a qualified income trust is to the nursing home facility or to the spouse, if she or he receives income diversion.

A pooled trust is another solution when excess income prevents an applicant from meeting Florida Medicaid qualifications.

A pooled trust can be substituted for a qualified income trust in cases where a pooled trust is already being used to rectify an excess asset problem.  An applicant need not have the extra hassle of having someone administer a qualified income trust under these circumstances. Pooled trusts are critical when an applicant with excess income is using the Medicaid benefit when utilizing home and community based medicaid either at home or in assisted living because of the flexibility allowed to pay expenses other than just the nursing home or the spouse.

While the Florida Medicaid Qualification criteria is widely publicized, self-help solutions can provide terrible unintended consequences.

I recently spoke to a family whose mother had excess income, roughly $1,200 over the income cap.  The family’s internet research had led them to identify the problem. They decided the solution was to contact the late husband’s pension provider and stop the pension payments.  Medicaid requires you to obtain all available benefits so this act could well have caused ineligibility itself. Further if home and community based services would ever been possible (by transferring the mother from a nursing home to assisted living) the family would have had to personally come up with the payment shortfall, instead of having the pension pay for needed care.

Give us a call to  allow us to help you navigate Florida Medicaid Qualifications.

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