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A Primer on Florida Medicaid (and Medicare)

Florida Medicaid is a topic we get asked about a lot.  Often, family members or clients reach out to ask us about Medicaid or Medicare, many times uncertain about the difference.  It can be confusing–even for the professionals who work in this field every day!

Florida MedicaidWe’ll start with a quick definition of Medicaid and how it differs from Medicare.  Medicaid is a joint federal-state program which provides various health-related benefits to individuals who meet financial qualifications.  The federal government provides funding and the states provide additional funding, as well as administer the wide array of specific programs that fall under the category of Medicaid.  You may have heard of a poor, young child receiving Medicaid to cover doctor’s visits and medications, while at the same time you may realize this is the program your grandmother qualified for to assist her in paying her nursing home costs when she had no money left.  This is what makes Medicaid so confusing–it covers a wide range of programs and the qualifications for each vary.  The important point is to understand that it is a means-tested program, administered by the states to cover health care for various groups considered low-income/vulnerable.

Medicare was also enacted in 1965, as a healthcare program for seniors (65 and older) and disabled persons.  Medicare is funded via payroll tax and NOT means tested.  If a person qualifies by paying in to the system via payroll tax (or in some cases, via a parent for example), he or she will be eligible regardless of income or assets.  To learn more about all the parts of Medicare, eligibility and related costs, you can download our free Medicare 2013 Fact Sheet**Though not a means-tested program, higher income individuals do pay some higher Medicare premiums and special help is offered to assist those with low incomes.

At Aging Wisely, the primary questions or concerns we get related to Florida Medicaid are:

1.  What programs will help me pay for long-term care (such as Mom’s nursing home bill, the help I want to hire in my home or Assisted Living)?

The important thing to understand when looking at this question is the mechanisms for paying for long-term eldercare (also called custodial care by entities like Medicare).  Medicare is not intended to pay for long-term or custodial eldercare.  The majority of elder care is provided by families, who offer a wide array of assistance (80% of the eldercare provided in the U.S.), but there comes a time when many families cannot provide all of the eldercare needed.  Some individuals have purchased long-term care insurance and are able to make a claim to have some or all of their long-term care needs covered, while others rely on their income and assets or other private financial tools.

Medicaid does have programs which cover long-term healthcare needs.  The biggest of these programs and common to all states (though rules and qualifications vary) is the nursing home program (also known in Florida Medicaid as the Institutional Care Program).  States also have various waiver programs that have been developed to find creative solutions to long-term care needs outside of nursing homes.  Some of these in Florida Medicaid include the Nursing Home Diversion program and PACE.  The various waiver programs may assist in paying for assisted living, home care and other supportive services for seniors or disabled adults.  All of these Florida Medicaid programs for long-term care have both financial and health status/care need qualifications.

Veterans also have some benefits available to them related to healthcare and long-term care.  Some of these include Veteran’s pension programs like Aid and Attendance which can assist in paying Assisted Living costs.  The Pinellas County Veterans Service office is a great resource on these programs and offers an overview on their website.

2.  How do I qualify for Medicaid or other assistance programs if I cannot afford my long-term care?

We feel it is critical to review the financial picture related to long-term care sooner than later (in other words, don’t wait until you feel you cannot afford the costs or are in a crisis, but look at finances as part of overall care planning).  Understanding a little more about costs and options can help guide decisions and allow you to more wisely use resources, no matter what your personal finances.  This is one of the reasons we highly recommend a care consultation or geriatric care management assessment early in the long-term care or eldercare process.

Because there are various programs, as well as different ways to structure an eldercare plan, knowing your options can really help you budget and make the best use of your resources.

Just to give you a snapshot of Florida Nursing Home Medicaid qualification in 2013, an individual’s gross monthly income cannot exceed $2130 and cannot have “countable assets” above $2,000.  However, there are numerous assets which are exempt or non-countable, and there are also various provisions for a well-spouse and a mechanism for dealing with income over the $2130 called a qualified income trust.

Because of the complexities, we emphasize the value of getting professional advice on these issues.  A qualified elder law attorney who specializes in Florida Medicaid keeps up with the law changes, qualification process and tools.  Getting proper professional advice can give your family a much better road map to navigate through long-term care.  Be aware that many well-meaning friends and community members may give you advice or tell you what they learned when helping someone, but it is no substitute for personalized, professional advice.

Get the right start: find out more about getting a care consultation with one of our geriatric and disability care managers to learn more about Florida Medicaid and Medicare, eldercare options, community resources and qualified professionals who can help you.

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Our goal is to enable every individual we work with to live the most fulfilling life possible, with utmost dignity, focusing on their physical, mental, spiritual, family and financial wellbeing.