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 just 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:
The following services are optional; however, most states will also offer them through Medicaid:
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:
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 fall into 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 retarded. 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, as a part of the Deficit Reduction Act, and beginning in 2007, all states are 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 HSBS program they wish to implement. Therefore, both the old waiver program and the new SPA option will exist concurrently. There is no federal requirement limiting the number of HCBS programs that a state may operate at any given time, and currently there are just fewer than 300 HCBS waiver programs in operation throughout the U.S.
In general, HCBS will pay for the following in-home services:
It is important to note that room and board of 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. There are many asset categories that are not countable. Therefore, the requirement of being destitute is a misnomer.
Spend-down means either expending countable assets on care or non-countable or exempt assets.
In Florida a home that qualifies as a primary residence that the patient has an intent to return to cannot be sold, have a lein placed against it or otherwise encumbered by a nursing home or Medicaid.
Veteran's homes in Florida generally are 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.
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Platinum Benefit Services, Inc. is committed to helping families gain maximum government benefits for Long Term Care and providing both compassion and application expertise. Since 1996, we have helped nearly 10,000 families qualify for Medicaid while strategically protecting an estimated $1,000,000,000 in assets in conjunction with appropriate legal counsel.