How to Apply for Benefits

Often family members will approach our firm with questions about Medicaid. What is Medicaid? What does it cover? Can I apply for benefits for my parents? Medicaid is designed to help pay for costs associated with long term care needs. Medicaid recipients include disabled persons as well as elders who require long term care. Medicaid goes beyond the coverage of Medicare for those who are chronically (long-term) in need of the care of others. Medicare covers its enrollees (most US citizens over 65 years old) for the costs of hospitalization and rehabilitation afterwards. Medicare covers the cost of the first 20 days of rehab at 100%, and 80% of days 21-100. (Treatment and coverage will cease when the patient has made enough progress in the rehab program.) For most, the additional 20% of days 21-100 will be paid for by their Medicare supplement. But Medicare does not pay for long term care. Those who are too sick to go home after the maximum days Medicare covers will need to look elsewhere to cover the costs of long term care.

If you have sufficient private assets to pay for long term care costs (around $10,000-$13,000 per month) or if you have long-term care insurance you can stop reading. (You might want to come back to this article if you long term care policy benefits have been depleted in a few years time.)

If your parent or loved one is in need of long term care and has more modest assets, you might be wondering how to apply for benefits for him or her. Click on the link below? to get a free guide on how to file a Medicaid claim.

How to Apply for Medicaid Guide

Even though Medicaid is a Federal program, each state sets its own rules for eligibility and filing requirements also differ. So please be aware that even if you filed Aunt Betty’s claim in Ohio last year you will need to master the Florida rules if you are filing for Dad who lives here. (The attached guide is Florida-specific. If you need to file in another state you should search for a guide from that state.)

The good news is that Florida’s rules are among the more generous rules about assets you can exempt and still receive Medicaid.

For example, Florida allows a spouse to protect over $100,000 in his or her name. Some states require the assets to be split and half spent down before eligibility. There is no look-back period or penalty for transfers between spouses in Florida. Florida also exempts real property if it is homestead or rental property. Both rental property and IRAs/401ks only count on the income side of the equation.

As you will find in the guide, an applicant for Medicaid must qualify with regard to both assets and income.

If you are concerned with being over asset be sure to consider the various ways you can re-position assets to become exempt or not countable assets. We do not advise giving away or trying to hide assets (it is wrong, and you will probably be caught) because there are so many exemptions you will not need to hide anything. Again I presuppose that those with sufficient private assets will not be reading this article.

If you are concerned with being over income ($2350 monthly gross income) there is a legal cure for that in Florida called a qualified income trust. You will need to prepare, execute and fund a qualified income trust. If you have done so your over-income problem is cured.

You may have heard that your parent will have to “spend down” to obtain Medicaid eligibility.

The idea here is that if they pay out at the rate of $10,000 or more monthly they will eventually deplete any level of assets down to qualify for Medicaid. This will work, but it misses the chance to preserve part or all of their assets to make their lives better. Many planning opportunities exist which are legal and reportable which can enrich your parent’s life. At least check it out in the policy manual as a consideration.

You may have heard that your parent will have limited choice of long-term care facilities if they are on Medicaid. If they are getting Medicaid due to their need for nursing home level of care, they can be in any long term care skilled nursing facility in Collier County. The only facilities which would not work would be the “buy-in” communities or continuing care communities. Many of these facilities s run rehab-based nursing facilities that are not designed for long term custodial care. Otherwise, all nursing homes in Collier County have some or all of their beds certified to allow Medicaid. If you are on the Medicaid waiver program which provides a limited monthly resource to help pay for assisted living your choices will be restricted to those facilities that accept Medicaid waiver.

We wish you luck in your filing!

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