Medicaid is the federally mandated, government-funded health program that gives low-income children, adults with disabilities and seniors access to essential health services. Each state administers its own Medicaid program, and by law, all Medicaid plans must provide these mandatory benefits:
- Doctor’s visits
- X-rays and basic lab services
- Long-term care
- Emergency care
- Inpatient and outpatient hospital services
- Transportation to Medicaid-funded services
- Home health services
States can also offer state-specific optional Medicaid benefits through special programs and Medicaid waivers that may include:
- Case management
- Prescription medications
- Vision testing and eyeglasses
- Dentures and dental services
- Enhanced early screening and diagnostic services
- Hospice care
- Personal and attendant care
- Prosthetics
- Private duty nursing
- Rehabilitation therapies
In Florida, the Medicaid program is administered by the
Department of Children and Families. Some long-term Medicaid services for seniors aged 65 and older are administered through the
Department of Elder Affairs.
Medicaid Income and Asset Limits Florida seniors who collect
Social Security Income benefits are automatically provided with aged, blind and disabled
Medicaid coverage. Additional screening is needed for SSI recipients who want to participate in Medicaid waiver programs.
All other seniors who need institutional and home and community-based Medicaid services must meet the following eligibility criteria:
- Be a U.S. citizen or hold valid immigration status
- Be a permanent resident of Florida
- Have a valid Social Security number
- Earn no more than $2,313 per month, or
- Earn no more than $4,626 per month in joint income when applying with a spouse, and
- Own no more than $2,000 in countable assets, or
- Own no more than $3,000 in countable assets when applying with a spouse
- Require the level of care normally provided in a nursing facility
Countable assets include all cash and investments, such as stocks, bonds and vacation properties. The applicant’s primary home is exempt as long as it’s occupied by the applicant and/or their spouse and is valued at $585,000 or less.
Minimum Monthly Needs Allowance Rule Under the community spouse resource allowance, a non-applicant spouse can keep half of the couple’s joint assets valued up to $126,420 in addition to any exempt assets.
The community spouse isn’t expected to contribute to their spouse’s care costs. If the community spouse is financially dependent on the applicant, the applicant can transfer up to $3,161 per month to the community spouse under the minimum monthly needs allowance rule.
Statewide Medicaid Managed Care Long-Term Care Program Seniors who qualify for institutional Medicaid coverage who can safely live in the community with additional services and supports may be eligible for the
Statewide Medicaid Managed Care Long-Term Care program.
SMMC LTC is a nursing home diversion program that funds long-term care services, such as personal care, skilled nursing, rehabilitation therapies and adult day health services. It also covers medical supplies and mobility aids, a medical alert system, nonemergency medical transportation and home-delivered meals.
Services are assigned based on the needs of each participant. Enrollees can reside in a noninstitutional setting, such as an assisted living facility, however, the SMMC LTC doesn’t cover room-and-board costs.
Eligible seniors need to complete the
Comprehensive Assessment and Review for Long-Term Care Services. This federally mandated assessment looks at the current and projected care needs of each applicant. The assessor recommends the most appropriate placement based on the findings of the assessment, which may be enrollement into the SMMC LTC.
For more information contact the
Area Agency on Aging for Southwest Florida at (866) 413-5337.