Frequently Asked Questions

The Florida Medicaid program provides medical coverage for Florida residents who meet the program's eligibility requirements. Once an individual is approved for Medicaid in Florida medical bills will be paid, primarily, by Medicaid.

These bills include not only nursing home care, but also hospital stays, home health care, home and community-based services, hospice, transportation, dental and vision care, community behavioral health, and prescription medications. (although in some cases, Medicare coverage may overlap this coverage).

The following services are required to be offered by all states, including Florida, under Medicaid:

• Nursing Facility Services for Individuals Age 65
• Nursing Facility Services for Individuals 21 Or Older If Determined Disabled
• Home Health Care for Individuals That Are Eligible For Nursing Facility Services
• Inpatient Hospital Services
• Outpatient Hospital Services
• Physician Services
• Medical And Surgical Dental Services
• Lab And X-Ray Services
• Family Nurse Practitioner Services

The following services are optional; however, most states will also offer them through Medicaid:

• Ambulatory Services For Individuals Who Are Entitled To Institutional Care
• Home Health Services For Individuals Who Are Entitled To Nursing Facility Services
• In-Home Assistance
• Prescription Drug Coverage
• Dental Services
• Prosthetic Services
• Optometrist Services and Eyeglasses

While Medicaid covers many services, there are a number of items that are not provided by this program. Medicaid does not cover the following services:

• Private Room, Unless It Is Medically Necessary
• Specially Prepared Food, Beyond That Which Is Generally Prepared By The Facility
• Telephone, Television, And Radio
• Personal Comfort Items, Including Tobacco Products And Confections
• Cosmetic, Grooming Items, And Services That Are In Excess Of Those Included In The Basic Service
• Personal Clothing
• Personal Reading Materials
• Gifts Purchased On Behalf Of a Resident
• Flowers and Plants
• Social Events and Activities That Are Beyond The Included Activity Program
• Special Care Services That Are Not Already Included In The Facility's Medicaid Payment

It is important to note that some exceptions may apply. However, exceptions must typically be medically necessary and ordered by a physician before the exception can be applied.

Unlike Medicare, there are some fairly strict financial rules with which one must comply in order to qualify for Medicaid's nursing home benefits. Yet, for those in need of this coverage, there are numerous strategies and combinations of strategies that can be used to qualify.

By using these strategies properly, with the guidance of a professional, proper care for a loved one can be obtained while preserving assets and income for a healthy spouse and / or other family member(s).

If an applicant is living in their home (i.e., not in a nursing home), the Medicaid program refers to them as living "in the community." In this case, Medicaid will still pay for certain services if the person qualifies. The basic test is whether the individual would otherwise require the level of care provided in a hospital, nursing facility, or intermediate care facility for the mentally handicapped. In other words, an applicant for home care must meet the level of care for some type of institutionalized care.

Many states - including Florida - have a program called "HCBS" This stands for Home and Community Based Services. Until recently, a state wishing to provide Medicaid assistance to elderly people outside the nursing home had to apply to the federal government for a specific waiver of the usual Medicaid rules. However, beginning in 2007 as a part of the Deficit Reduction Act, all states are now eligible to offer this program now without first having to obtain a federal waiver by submitting a state plan amendment setting forth the scope of the new HCBS program they wish to implement. 

In general, HCBS will pay for the following in-home services:

• Case Management
• Personal Care Services
• Respite Care Services (I.e., Care For The Patient In A Nursing Home For A Few Days In Order To Give The Home Care Giver A Needed Break)
• Adult Day Care Services
• Homemaker / Home Health Aide Services
• Habilitation (I.e., Assistance For People In Furthering Their Skills In Areas Such As Mobility, Social Behaviors, Self-Care, Basic Safety, Housekeeping, Personal Hygiene, Health Care, And Financial Management)

It is important to note that room and board for the HCBS recipient are not covered and that home care is very limited even when full qualification is obtained.

It is true that an applicant must be poor in countable assets. However, there are many asset categories that are not countable. Therefore, the requirement of being destitute is a misnomer.

"Spend-down" refers to either expending countable assets on care, non-countable, or exempt assets.

In Florida, a home that qualifies as a primary residence to which the patient has an intent to return to cannot be sold, have a lien placed against it, or otherwise encumbered by a nursing home or Medicaid.

Veteran's homes in Florida are generally not 100% covered by the VA and require an additional payor source like private pay or Medicaid.

Medicaid is complicated and few people have a thorough understanding of the rules.

Yes, there are many ways to protect assets without breaking laws.  A qualified attorney must make the initial determination regarding asset protection strategies in Florida.  An attorney does not have to be a "Board Certified" Elder Law Attorney.

A non-attorney can file an application for Medicaid.  A quality filing service will work in conjunction with an attorney selected by the client for asset protection strategies.