Medicaid is the federally mandated health plan for low-income individuals of all ages. It provides 16% of Florida residents with access to basic health services, including emergency, primary and long-term care, hospital services, X-rays and lab testing, in accordance with federal law. Additional services, such as home and community-based care, may be offered by individual states.
To enroll in Medicaid, applicants need to meet income and asset (resource) criteria. Florida seniors who already receive Social Security Income benefits are automatically eligible for Medicaid, and they only need to complete additional screening if they’re seeking long-term Medicaid services.
All other seniors must earn no more than $2,313 per month ($4,626 per married couple) and own no more than $2,000 in countable assets ($3,000 per couple). Some items, such as personal clothing and jewellery, one vehicle and a home owned and occupied by the applicant and/or their spouse valued at no more than $585,000, are exempt from the Medicaid asset limits.
Spousal Income and Asset Exemptions
When only one spouse needs long-term Medicaid coverage, special rules regarding the income of the non-applicant (community) spouse and the couple’s joint assets apply.
Under the minimum monthly maintenance needs allowance, the community spouse may collect up to $3,161 per month in income transferred from the applicant to pay for shelter costs, and this amount is deducted from the applicant’s declared income.
The community spouse can also keep the lesser of half of the couple’s joint assets or $126,420 under the community spouse resource allowance.
Comprehensive Assessment and Review for Long-Term Care Program
In accordance with federal law Florida, seniors who qualify for long-term Medicaid and require the type of care normally provided in a nursing facility must be screened through the Comprehensive Assessment and Review for Long-Term Care Program before being provided with Medicaid-funded long-term services.
A designated CARES assessor or registered nurse evaluates the current and projected care needs of each senior to determine the most-appropriate placement and Medicaid services.
Statewide Medicaid Managed Care Long-Term Care Program
A CARES assessment may recommend enrollment in the Statewide Medicaid Managed Care Long-Term Care Program, a nursing home diversion program that funds enhanced home and community-based services to let seniors age in place in an assisted living setting.
SMMC LTC services are administered through a managed health care plan. In Brevard County, the available LTC plans include Aetna, Humana, Sunshine and United. Once participants select an LTC plan, they can change to another available plan within 90 days, after which time participants can switch plans after one year.
Seniors who are enrolled in the SMMC LTC program are provided with services that are medically-necessary to prevent placement in a nursing home. These services may include:
- Skilled and intermittent nursing care
- Homemaker services
- Speech therapy
- Medication administration
- Personal care to assist with bathing, dressing and grooming
- Transportation to medical appointments
- A wearable medical alert device
- Mobility equipment
- Medical supplies
- Adult day health care
- Physical therapy
Participants are also provided with
additional benefits that aren’t normally covered under Medicaid, such as over-the-counter medications, dental and vision services, and help transitioning from a nursing facility into an assisted living community.
For more information about Florida Medicaid and the SMMC LTC, contact the Brevard County Elder Helpline at (407) 514-0019 or ACCESS Florida at (866) 762-2237.