Long Term Care Information

Medicaid: 2012 Long Term Care Information Sheet

(Prepared for informational purposes only & not intended as a substitute for legal advice).

Note: The information provided below is based upon current laws and regulations, both state and federal. Because Medicaid laws and regulations are subject to change, it should be understood that any planning entails risks that cannot always be anticipated.

How much does long term care normally cost?

Private care in the home averages $18-$30 per hour and 24-hour care can cost $125,000 or more per year. Assisted living facilities range from $2500 to $6500 per month, depending upon the level of care that an individual needs. Nursing home care costs for a semi-private room alone average $200 or more per day in our area.

Are government benefits available to assist in paying for long term care costs?

The Medicaid program, founded in 1965 concurrently with Medicare, is the primary government program that helps with the cost of long term care. Unlike Medicare, which is funded and directed solely by the federal government, Medicaid is a joint enterprise between the state and federal governments. There are many different programs of assistance within the Medicaid system. In Florida, the nursing home program is called “Institutional Care Program”, or “ICP”. Persons eligible for ICP receive financial assistance for the costs associated with residing in skilled nursing facilities (nursing homes). Medicaid generally does not pay for assisted living; although a limited Medicaid waiver program and a “diversion” program may provide relief for some eligible residents. The cost of living at an assisted living facility must usually be privately paid. Consult this brochure on ICP for more details.

Once an individual meets eligibility requirements for ICP, his or her total gross monthly income is paid to the facility, less a personal needs allowance ($35) and any income permitted to be kept by a spouse living at home. Medicaid will then pay for almost all costs, including room and board, and supplies. Medicare D covers the cost of Medications for those who enroll and pay monthly premiums and deductibles. Laundry and hair care are not covered.

In Florida, eligibility determinations for the Medicaid program are administered through the Department of Children and Families (DCF). Program eligibility is determined in the office of Adult Payments. Medical assessments are done by the CARES team, housed in the Department of Elder Affairs.

How can an individual qualify for Medicaid assistance?

There are three basic eligibility criteria for Medicaid ICP assistance:

1. Level of Care: An applicant must need nursing home care and must receive it in a Medicaid ICP approved facility. Required ICP levels of care include Skilled, Intermediate I, and Intermediate II. The level of care is independently verified by a CARES team from the Department of Elder Affairs (DOEA). Florida law (under Chapter 400) defines the levels of care that can be provided for adult family care homes, assisted living facilities, and skilled nursing facilities. Facilities cannot give a higher level of care than the law allows and must discharge the resident to the next highest level of care if the patient’s needs exceed the statutory limits.
2. Income: Florida is one of a handful of states which has established an income cap as a method of limiting eligibility. Individual applicants whose gross monthly income exceeds the cap do not qualify for ICP assistance without establishing a “qualified income trust”.
   2021 Income Cap: $2,382 per month

Note: DCF has taken the position that a Qualified Income Trust cannot be executed by an individual other than a spouse unless that individual holds a power of attorney permitting the execution of the trust. Powers of attorney executed after October 1, 1995, must have specific authority to create the trust. In the absence of a power of attorney, it may be necessary to seek the appointment of an emergency temporary guardian.

1. 3. Asset Limits: Applicant: $2,000 – Spouse: $130,380

Exempt Assets (not counted to determine eligibility) include:

• Homestead property
• One Automobile
• Home furnishings
• Life insurance (face value cannot not exceed $2500)
• Pre-paid funeral and burial: Irrevocable – unlimited
  Revocable – value cannot exceed $2500

Spouses have 90 days after approval of the Medicaid application to complete the transfer of jointly held assets into the Community Spouse’s name alone. All excess resources must be spent down before the applicant will be eligible for benefits.

Common Mistakes Made by Clients Attempting to Plan for Medicaid ICP Qualification

• Transferring the home (or some portion of the interest in homestead property) to a non-spouse, or otherwise diminishing the nature of a homestead interest
• Believing that the IRS annual gift tax exclusion (now $15,000 per year) applies to Medicaid planning transfers
• Giving assets away with no understanding of the rules relating to transfers of assets
• Transferring assets without legal authority
• Failing to disclose known income, assets, or transfers
• Failing to count all gross income in determining the necessity of income trust
• Failing to consider the personal autonomy and independence of the applicant

The information contained on this web page is for informational purposes only and is not be to used as a substitute for legal advice. Call our office for more information and a consultation.