This page is dedicated to providing a brief outline of eligibility criteria and some of the programs available in Florida.  See also Medicaid Planning page on this website for more information.

GENERAL ELIGIBILITY

• At least 65 years of age or disabled

• Citizen of United States or an alien who has been admitted as a permanent resident

• Resident of Florida.  Anyone residing in a nursing home which is certified for Medicaid is considered to be a resident of Florida

• Medicaid “medical need” for nursing home care has been established by the CARES team of the Department of Elderly and Veterans Services.

MEDICAL NEED REQUIREMENT

• Determined by the Department of Elderly and Veterans Services CARES unit and is based on Activities of Daily Living (Feeding oneself, transferring, bathing, Continence, Toileting, Cognitive abilities).

ASSETS REQUIREMENTS – MEDICAID “COUNTABLE ASSETS”

• Individual applying for ICP Medicaid - Countable assets of less than $2,000 in at least one day of each month of Medicaid eligibility.  If the individual’s gross income is less than $674.00 per month (2009), the individual is allowed to have up to $2,000 in assets.

• Married and one spouse applying for ICP Medicaid – Applicant cannot have over $2,000 in assets. Community spouse can have up to $109,560 (2009) in countable assets in his/her name.

• Both spouses applying for ICP Medicaid  - Countable assets cannot exceed $3,000

• Transfers of assets for less than fair market value (a gift) ,creates a possibility for ineligibility. The look-back period beginning for all transfers/gifts for a Florida Medicaid applicant made after November 1, 2007, will now be 60 months (phased in over next 60 months).  All transfers prior to November 1, 2007 will be subject to the old 36 month look-back and the old rules. Pre-November 2007 Medicaid rules will apply for treatment of those transfers (Trusts have specific look-back periods – 60 months, depending on the type of trust.) 

• NOTE: Under the new law the penalty period will begin as of the date of application, where the applicant is otherwise eligible but for the transferred assets. The penalty will now be applied going forward from that date.

INCOME LIMIT REQUIREMENTS OF APPLICANT – MEDICAID

• Monthly GROSS available income of applicant cannot exceed the State Income standard of $2,022.00 (2009 Cap).

• The Florida Department of Children and Families – Economic Self Sufficiency adult services unit administers and verifies this information.  There are guidelines they follow for determining what is and is not considered an applicants “Income”

EXEMPT ASSETS (Medicaid does not count)

• Homestead – so long as the applicant “intends” to return home. Also a homestead lived in by a spouse, disabled child, or sibling who has resided there over 2 years and providing care to applicant.  Under the new Deficit Reeducation Act of 2005 (DRA 2005) as applied in Florida, the applicant can have up to $500,000 in equity in the homestead.  Any amount of equity in excess of this is considered a countable resource.  This cap does not apply if a spouse or other qualified dependent lives in the home.

• Certain additional real property if rented or listed for sale at fair market value.

• Certain property used in trade or business.

• Certain Income producing property.

• One Vehicle – regardless of age or value used to transport applicant for medical reasons

• Additional vehicle(s) – Used for transportation

• Term Life insurance

• Life insurance – with cash value – if the total face - value of all life insurance policies is less than $2,500;

• Irrevocable burial/funeral contracts (unlimited value). Note, under Florida probate code, $6,000 is considered a reasonable amount for funeral costs.

• Burial set aside funds up to $2,500 designated for burial expenses – Includes revocable burial contracts, bank accounts designated for burial by notation in the title, or life insurance policies with designation to pay burial costs.

Nursing Home Institutional Care Program (ICP) Plus

11 other Medicaid State Funded Waiver Programs

Ø       ICP Program (Nursing Home)

Ø       MEDS-Aged and Disabled Waiver Programs

1.       ALF Waiver for the Elderly Program

2.       Home Community Based Waiver Program

3.       Long-Term Care Nursing Home Diversion Waiver Program

4.       Channeling Program (Over 65) – 2 Hours/day custodial care, Day Care voucher, contract caregivers. (Miami-Dade and Broward County Florida only)

5.       Developmental Disabilities Waiver (Adult/Disabled Children)

6.       Aged and Disabled Adult Waiver (Component of DSW)

7.       Brain Injury/Spinal Cord Injury Waiver

8.       Model Waiver (Katie Beckett/Spino-Cerebral Disease - Children)

9.       Project AIDS Care Waiver

10.   Adult Cystic Fibrosis Waiver

11.   Supported Living Waiver

Other Programs

1. Medically Needy (Available when one cannot qualify for Medicaid, but has high medical bills.  Medical bills are submitted to Medicaid and paid through this program)
2. Hospice
3. MEDS-AD - Over 65 totally permanently disabled income less than 88% of Federal poverty Level. (Being phased out as of 2009)
4. Alzheimer’s Disease Initiative (Run out of SE/SW Focal Point - Broward)
5. Optional State Assistance (Indigent/No assets)
6. Community Care for the Elderly (No Income /asset test. Wait list is very very long and program is full)
7. Medicaid Programs related to paying for Medicare (Qualified Medicare Beneficiary) Income cannot exceed 100% of Federal Poverty Level and must be receiving getting Medicare Part A
8. SLMB- (Special Low Income Medicare Beneficiary) Income exceeding 100% but less than 120% of Federal Poverty Level and one must be entitled to Medicare Part A to qualify
9. QI1 (Qualifying Individuals I – (Part B Medicare Only). Income exceeds 100% but less than 135% of Federal Poverty Level.