Medicaid is a nationwide health insurance program that is jointly funded by the federal government and each state. It provides limited health coverage to low-income children, adults and seniors who have very few assets. In Florida, the Agency for Health Care Administration administers Medicaid.
Seniors aged 65 and older who are residents of Florida must meet specific financial criteria to qualify for Medicaid coverage. Single seniors must earn less than $2,313 per month and have countable assets valued at $2,000 or less. Couples applying for Medicaid together must have a joint income of less than $4,626 per month and have $3,000 or less in countable assets.
Medicaid includes income from all sources, such as wages, pensions and investment interest. Countable assets include cash, bank account balances, stocks and all real estate except for a principal residence worth $585,000 or less. One vehicle, household furniture, clothing and jewelry are also excluded under Medicaid asset rules.
As with all states except California, Florida has a five-year Medicaid asset look-back period. Medicaid applicants may be subject to ineligibility penalties levied on any countable assets they gifted or transferred during the five years prior to their Medicaid application. Look-back penalties are calculated by dividing the total market value of any “uncompensated transfers” during the look-back period divided by the average cost per month of a private-pay nursing home.
Seniors in Florida who qualify for Medicaid coverage and have nursing home-level care needs may be eligible for assistance through the Florida Statewide Medicaid Managed Care, Long-Term Care Program, or SMMC LTC.
This program is designed to delay or prevent nursing home placement among older adults by providing additional care services in the community and assisted living facilities. Services through the LTC program are delivered according to medical necessity as determined by each individual’s managed care plan.
LTC services may include:
- Assisted living facility services
- Medical supplies and equipment
- Medication management and administration
- Occupational, speech, respiratory and physical therapy
For more information on Medicaid and the Statewide Medicaid Managed Care, Long-Term Care program in Florida, contact the Agency for Health Care Administration at (877) 711-3662 or the Florida Elder Helpline at (800) 963-5337.