By: Kevin R. Albaum, Esq.
Clark, Campbell, Lancaster & Munson, P.A.

Medicaid is a joint federal and state health insurance program that will help many people with limited income and resources pay for their health care. For those with disabilities or illness and no funds available to pay for care, Medicaid health insurance is often the only option available to pay for their medical services.

Since 1972, Retroactive Medicaid Coverage (“RME”) has been available for individuals to receive Medicaid coverage up to three (3) months before they have even submitted an application for Medicaid benefits. The goal of RME was to protect people that were eligible for Medicaid benefits but did not know to apply for assistance until after they had received medical services or because a sudden injury or illness prevented them from applying timely for assistance. RME meant that individuals (that truly had minimal assets or income) who ended up in a health crisis would be able to receive benefits to pay providers for care they had received. However, Florida RME is no more.

The State of Florida requested and received authority from the Centers for Medicare and Medicaid Services to eliminate RME. Effective February 1, 2019 Florida has eliminated RME for most Medicaid programs in the state. RME will only remain in effect for pregnant women or children under age 21. However, everyone else that may need coverage (such as an elderly woman in a nursing home or a 30-year-old in a catastrophic car accident) will not have this option to pay for their medical services. To receive Medicaid benefits, a person must now file for benefits in the month they received medical services.

The goal of cutting RME is to save the state and federal governments substantial funds in their annual budget appropriations. It is estimated that cutting RME in Florida will save the state and federal government footing the bill for Medicaid approximately $98 million per year. However, the government’s savings will result in medical providers almost certainly not receiving any private pay or insurance payment for many services they are providing to these people (as people who need Medicaid have very limited income or resources). In turn, this may lead to higher future costs for medical services to those of us that are able to pay for our medical services.

As an elder law attorney, I often come across seniors (sometimes incapacitated seniors) with minimal or no assets that are not even aware that they need Medicaid to pay for their nursing home care. They might not find out until after their primary insurance benefits (Medicare and/or Tricare) have been fully exhausted and when insurance companies refuse to pay for any further skilled nursing care. RME is vital for these seniors to avoid discharge from the nursing home for non-payment. Only time will tell if the elimination of RME was a good thing that saved our state and federal governments (and us as taxpayers) substantial money or a bad thing that financially harmed our medical service providers (with large accounts receivable from people that cannot afford to pay their medical bills) and those people who already had no means to pay for their own medical services.

It is more imperative now than ever to have a basic understanding of Medicaid programs for senior care so that family can act quickly to gain eligibility for these benefits if they are ever needed in the future. Elder law attorneys typically specialize in this area of the law and can assist in proactive planning to pay for senior care in the future.

Kevin Albaum is a shareholder in the Elder Law Practice at Clark, Campbell, Lancaster & Munson, P.A. Questions can be submitted online to thelaw@cclmlaw.com.

By: Kevin R. Albaum
Clark, Campbell, Lancaster & Munson, P.A.

A person’s transition to a skilled nursing facility (a/k/a “Nursing Home”) is often a very difficult time for a family. Not only is the person’s physical or mental health often declining but the person and/or their family is often burdened with figuring out how to pay for the facility. Health insurance coverage often will pay for the first few days or months at the Nursing Home but that eventually stops and the cost of a Nursing Home once health insurance is no longer paying often gets exorbitant even for the middle-upper class (the monthly cost for a private pay resident at many Nursing Homes can often exceed $10,000.00 per month). This results in residents no longer being able to afford the Nursing Home and having only two (2) options to pay for their care: (1) qualify for Medicaid Nursing Home coverage or (2) pay the private pay rate any way possible by selling off all assets, impoverishing the spouse at home (the “Community Spouse”) or getting financial help from their children. Many decide to pursue the first option.

In order to qualify for Medicaid Nursing Home coverage in Florida, an applicant must pass a three (3) part test that looks at a person’s assets, income, and health at the time they file the Medicaid application. The scope of this article is just to discuss the basics of the asset and income eligibility tests for Medicaid Nursing Home coverage in Florida in 2019.

Income: Effective January 1, 2019, an individual can have a maximum of $2,313.00 per month in income (before deductions) in order to be eligible for Medicaid Nursing Home coverage. However, if an individual’s income is above that figure, then proper legal planning to create a qualified income trust will be often utilized in order able to make the individual eligible. However, timing is very important because if the income trust is not set up properly and funded properly, an individual will still not be eligible for Medicaid. There is a common misconception that a Community Spouse’s income being too high will limit the applicant spouse from obtaining Medicaid eligibility, however, a Community Spouse’s income can be unlimited and it does not impact a Medicaid applicant’s eligibility for Medicaid benefits.

Assets: Effective January 1, 2019, an individual can have a maximum $2,000.00 of countable assets and be eligible for Medicaid Nursing Home coverage. However, if an individual’s countable assets are above that threshold there are often a multitude of legal planning options available in order for the individual to become eligible for Medicaid Nursing Home coverage. There are two (2) types of asset classes to consider when applying for Medicaid Nursing Home coverage: Countable Assets (assets that impact Medicaid asset eligibility) and “Non-Countable Assets” (assets that are not calculated into Medicaid asset eligibility). Some Non-Countable Assets are as follows: homestead property up to $585,000.00 in value; one automobile of unlimited value; a prepaid burial contract with a nursing home (in most circumstances) and term life insurance without a cash value. Most other items such as bank accounts, investment accounts, life insurance with a cash value, CDs, annuities, etc. are considered Countable Assets. There is also a common misconception that a Community Spouse must also not have any assets in order for their spouse in the Nursing Home to be eligible for Medicaid benefits. Effective January 1, 2019, a Community Spouse can have a maximum of $126,420.00 of countable assets without impacting their spouse’s Medicaid eligibility.

Obtaining Medicaid eligibility and understanding the income and asset tests can be incredibly complex to those who are new to the subject, therefore, it is highly recommended that a qualified elder law attorney assists you in obtaining Medicaid financial eligibility before you file a Medicaid application.

Kevin Albaum is an attorney in the Elder Law Practice of the law firm Clark, Campbell, Lancaster & Munson, P.A. Questions can be submitted online to thelaw@cclmlaw.com.