FAQs About Medicaid

Does Medicaid Pay for Nursing Homes?

Medicaid recipients can receive all-inclusive care at a nursing home without paying out-of-pocket expenses. Care is not limited to room and board and on-site physician services. The all-inclusive nature of the coverage also includes laundry services, personal hygiene items, activity services, and more.

However, for Medicaid to pay for a nursing home, the person must meet eligibility requirements. Because Medicaid is generally only available to seniors over 65, other funding sources may have to be used to pay for a nursing home until Medicaid benefits become active.

When Should Someone Begin Planning for Medicaid Eligibility?

You should begin thinking of your loved ones’ plans for Medicaid eligibility as soon as possible to ensure they do not start too late or fail to meet the requirements. Planning for Medicaid eligibility should begin at least five years before age 65. Medicaid eligibility can significantly affect ongoing living expenses and a family’s financial legacy. Ask your attorney about combining estate planning and Medicaid planning.

What are the Income and Asset Requirements that Determine Medicaid Eligibility?

A person’s income and assets determine Medicaid eligibility. For the elderly who carefully planned for retirement, significant income or accumulated assets could lead to denial of Medicaid benefits, which could then cause financial woes ahead. The income and asset threshold an applicant cannot surpass is relatively low. In Florida, an “income cap state,” the current gross income limit is $2,523 per month. The state also looks at assets that could be liquidated as income.

The American Council on Aging has a preliminary Medicaid eligibility test one can take to determine if they meet the requirements.

However, this test does not account for estate planning instruments, such as trusts, that can shield income and assets from the Medicaid eligibility equation. Working with a Medicaid lawyer can help to position your loved ones to qualify for Medicaid, even if they have substantial income and assets.

Can Medicare Also Cover Nursing Home Care In Addition to Medicaid?

Elderly citizens who are “dual eligible” may have both Medicare and Medicaid. For people with Medicare only, Medicare will cover some of the cost of a nursing home.

However, Medicare coverage is limited to short-term visits only. Full coverage applies for stays of up to 20 days. After that, as the stay extends up to 100 days, the patient is responsible for a significant portion of the fees—subject to whether they have a supplemental insurance policy. From the 101st day in a facility, Medicare no longer helps with the cost. Therefore, working with a Medicaid planning attorney is critical to prepare for long-term care in a nursing home.

Does Medicaid Cover Other Long-Term Care Options?

Yes. If your loved one opts for in-home care, Medicaid can also cover the costs associated with promoting independent living.

Depending on your situation, you may prefer that a loved one stays at home as long as possible, but you may also have concerns about the costs associated with this option.

In independent living situations, Medicaid pays for:

• Daily living assistance
• Household chores (including meal preparation)
• Home modifications, such as wheelchair ramps and roll-in showers
• Vehicle modifications
• Adult daycare
• Medical supplies
• Transitional services

Discuss your unique goals and concerns about Medicaid planning with your Florida Medicaid attorney.