Approximately 88% of Florida residents age 65 and older or disabled are eligible to receive basic health care coverage through Medicaid, the nationwide health insurance program jointly funded by the federal and state governments.
Florida seniors who qualify for federal Supplemental Security Income are automatically eligible for Medicaid. Enrollees who are Medicaid-eligible because they receive SSI are required to file an ACCESS Florida application if long-term care services are required.
Medicaid is designed to support low-income, low-asset Americans. Among seniors, enrollment is restricted to those who meet the following criteria:
- Monthly income from all sources below $2,313 per person or $4,626 per couple
- A maximum of $2,000 in countable assets per person or $3,000 per couple, including cash, investment real estate, stocks and bonds
- If applicants own a home, it must be valued at no more than $585,000
Medicaid also exempts one vehicle, a non-revocable burial trust, household furnishings and personal effects such as clothing and jewelry.
Note that Florida is a Medicaid income cap state, which means applicants are not allowed to spend down excess income in order to reach the income standard for eligibility.
Seniors with excess income may be able to qualify for long-term care services through Medicaid by setting up a
Qualified Income Trust, also known as a Miller Trust. This non-revocable legal agreement requires seniors to deposit enough money into the QIT each month to meet Medicaid income limits. The funds in the QIT can only be used for specific health-related expenses.
Medicaid-eligible seniors who require the level of care normally provided in a nursing home must be screened by the
Comprehensive Assessment and Review for Long-Term Care Services program. This process identifies the specific services a senior requires and makes recommendations regarding long-term placement.
Following CARES screening, seniors may be referred to the
Statewide Medicaid Managed Care, Long-Term Care Program. This program reduces nursing home placements by providing needed services within an assisted living setting, which may include:
- Adult day health care
- Attendant or homemaker services
- Intermittent skilled nursing
- Medication administration and management
- Case management
- A personal emergency call system
- Transportation and adult companion service
To apply for Florida Medicaid coverage, request CARES screening for long-term care services or obtain more information about a QIT, contact the
Sumter County Elder Helpline at (800) 262-2243 or call the
Florida Department of Children and Families at (866) 762-2237.