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Frequently Asked Questions

The Institutional Care Program (ICP) is a Medicaid program that helps people in nursing facilities pay for the cost of their care plus provides general medical coverage. ICP eligibility is determined by the Department of Children and Families (DCF). In a nursing facility, patients pay for services through private insurance or self-pay, or through Medicare, or Medicaid. The level of care is either skilled or intermediate. Medicaid can pay for intermediate & skilled care for an unlimited time period. 

The individual or their designated representative may apply. If there is a legal guardian, the guardian must apply unless the legal guardian fails to cooperate or cannot be located. Some eligibility requirements include:

  • Be 65 or older or disabled as determined by Social Security criteria.
  • Be a U.S. citizen or qualified noncitizen.
  • Be a Florida resident.
  • Have a Social Security number or apply for one. 
  • File for any other benefits for which you may be eligible (i.e., pensions, retirement, disability benefits, etc).
  • Tell DCF about other third party medical coverage (i.e., health insurance).
  • Be determined to be in need of nursing facility services. 
  • Be placed in a nursing home that participates in the Medicaid program.
  • Have assets and income within the program limit. 

Individuals with income over the ICP income limit, $2349 monthly, may still be eligible if they set up a “qualified income trust” and deposit sufficient funds every month into the “qualified income trust” account so their income outside the trust is less than the income limit. To qualify, the “qualified income trust” must: 

  • Be irrevocable; 
  • Be comprised of income only; and, 
  • Designate that the state will receive any funds remaining in the trust upon the death of the recipient, up to the amount of Medicaid payments paid on behalf of the individual. 

 



The asset limit in Florida is $2000 (though some states have higher and lower limits), which means that a care recipient will not qualify to receive Medicaid if he or she has more than $2000 in total assets.

However, there are numerous exclusions to the Medicaid asset test that can protect significant amounts of assets. For example, in many states if you are married and receiving nursing home care through Medicaid, your spouse is allowed to keep $128640 as a community spouse benefit.

Additional asset exclusions exist, which means that the $2000 limit can be very misleading.



The application process can be very complex and time consuming, especially when asset and/or income protection strategies are involved.  An application for Medicaid, handled incorrectly, can take many months, to complete.  Handled correctly, the application should be approved in 30 - 45 days.  There are exceptions for various reasons, but rarely should an application take more than 90 days.  Keep in mind, if the assets and income were properly handled, the application will be approved beginning the first of the month for which the application was filed.  For example, if an application is filed on March 31st but approval is not granted until May 23rd, the approval would begin March 1st.

It is important to understand the timing of an application when accessing Medicaid funds. For example, the application referred to above, submitted on March 31st, would be eligible for one more month of benefits than an application filed on April 1st.  Further, among many other reasons, missing a deadline for submitting additional requested information can cause an application denial.  Having an expert application processing company like Platinum Benefit Services, Inc. complete a Medicaid application on your behalf, advocate for application approval, and follow the application through to final approval can save your family tens of thousands of dollars.
After the individual is determined eligible, a special budget is used to determine the monthly amount the patient is responsible to pay. In general, all of the patient’s monthly income, except for $130 for personal needs, must be paid to the nursing facility for the patient’s care. This includes any funds deposited into a “qualified income trust”. The payment to the facility is called the “patient responsibility”. All or part of the patient’s income may be set-aside for the spouse or dependents, reducing the amount the individual must pay to the nursing facility each month. Another deduction that may be subtracted from the patient responsibility is uncovered medical expenses such as health insurance premiums (other than Medicare) co-pays and deductibles. In some situations certain Veteran’s Administration (VA) payments will also be deducted in the budget. The eligibility worker calculates the patient responsibility amount. 

The rules differ by state, but in Florida, the primary residence is an exempt asset as long as the applicant has an "intent to return" and the equity in the home is equal to or less than $595000 OR has a spouse living in the home and the equity in the home is equal to, or less than, $595000.

While the attorney that recommends asset protection strategies will ultimately determine if your home meets the designation of exempt, for most people, the term "home" coupled with an ownership interest is adequate to understand what constitutes "homestead" property for purposes of Medicaid.

Yes there are many ways to protect assets, and even income, while still qualifying for Medicaid benefits.

The basic concept is to exchange assets and income that Medicaid counts against qualification for assets that Medicaid does not count against qualification.

In Florida, a qualified attorney must make the initial determination of the appropriate asset protection strategies available for a particular client.  However, an attorney does not have to be a “Board Certified” Elder Law Attorney to determine the appropriate strategies, recommend and draft appropriate legal documents, or apply for benefits if they so choose.  While the "Board Certified" status does require the passing of an exam regarding a broad range of elder care issues, the designation does not guarantee that the attorney will know, understand, or recommend the most cutting edge strategies to qualify for Nursing Home Medicaid.  Further, the designation does not guarantee Medicaid approval.  There is nothing wrong with the designation, in fact, in the absence of any other guidance regarding the competency of an attorney in the field of "Medicaid Planning" there is merit to the idea that the designation would increase the odds of finding an attorney with the needed knowledge over a random attorney selection. 

However, while strategy determination and document creation are important, the real work and skill lies in the implementation of the recommended strategies and the processing of the application.  The processing company must understand the strategy, the legal documents, how to interface with financial companies, various professionals, family members, the nursing home, Medicaid personnel, and so much more.

When using a quality processing company a money back guarantee will be provided that assures a full return of any fee paid if the processing company fails to obtain Medicaid approval for the month agreed upon at the time of hiring the company.  While it should never be necessary to collect the refund, it should provide reassurance that such a guarantee is offered.

In summary, there are various legal strategies and processes that can be implemented to obtain Medicaid benefits without breaking laws.  The best approach is a team approach.  The team should be familiar with each other and work in tandem to accomplish the goals of the client.

Your mom does not have to spend all of her assets to qualify for Medicaid. Platinum Benefit Services, Inc. is an industry leading Florida Medicaid application processing firm. Platinum, when appropriate, will refer you to an attorney who will recommend the appropriate asset protection strategy to protect your mom’s assets. Platinum will then work at the direction of the attorney to ensure the smooth and timely administrative processing of the protection strategies and the Medicaid application. 

Yes. The “Income Cap” in Florida is currently $2349 gross, per month. A patient that receives more than the “Income Cap” per month is disqualified from receiving Medicaid long-term care unless a special legal document, which should be drafted by an attorney, is created which will artificially lower the gross income below the $2349 threshold.

Yes. Medicaid allows a personal needs allowance of $130 per month for personal items.  Some other deductions from the “deductible” are allowed such as health insurance premiums and VA Aid and Attendance of $90.

You should start exploring all your options immediately upon actual admission to a nursing facility. A Platinum representative will meet with you at no charge to explain the Medicaid application process and discuss all payer options including Medicaid relieving the overwhelming stress associated with paying for nursing home care . The initial consultation is free of charge and without obligation.

Platinum Benefit Services, Inc. has successfully filed and received approvals on more than 6,000 cases to date. Platinum has a full time staff dedicated solely to preparing, submitting and tracking each case through the entire process until approval is attained. 

The application process can be daunting; requiring constant monitoring, information submission, corrections of the Department of Children and Families (DCF) errors, and enforcement of time frames. While attorneys may be knowledgeable about  protection strategies and preparation of legal documents, attorney offices often do not have extensive Medicaid application processing expertise or the systems or staffing necessary to ensure the application is filed and approved in a timely manner. The cost of long-term care can be well in excess of $200.00 per day.  A delay in eligibility for any reason may result in the family paying many thousands of dollars in unnecessary costs.

Platinum will work at the direction of the attorney to administratively carry out the necessary steps in the application process necessary to protect all of your mom’s assets, maximize income for mom’s spouse (if any), correct any unknowing mistakes made by the family (gifts, commingling of funds, selling assets for less than fair value, etc.), collect and organize required documentation, verify income and assets, then prepare and submit the application. Once the application is submitted, Platinum will track the progress of the application and intervene, when necessary, until approval is attained in a timely fashion. Unlike attorneys, who typically charge by the hour, Platinum charges a flat fee.  Also, unlike attorneys, Platinum GUARANTEES application approval!

IRAs and Retirement accounts provide income tax breaks, but the money in them doesn't get any special treatment by Medicaid. If you apply for Medicaid, IRAs and Retirement accounts in your name are considered "Countable" assets. The fact that you would lose your tax break if you tapped into the IRA or Retirement funds too early doesn't protect them from consideration by Medicaid.

There are, however, many options available to convert IRA/Retirement accounts from being treated as a "Countable" Asset to a "Non-countable" Asset. Your Elder Attorney will discuss options available to you when preparing YOUR Medicaid Asset Protection Plan.

The expense of nursing home care — which ranges from $8,000 to $10,000 a month or more — can rapidly deplete the lifetime savings of elderly couples. In 1988, Congress enacted provisions to prevent what has come to be called "spousal impoverishment," leaving the spouse who is still living at home in the community with little or no income or resources. These provisions help ensure that this situation will not occur and that community spouses are able to live out their lives with independence and dignity.
Under the Medicaid spousal impoverishment provisions, a certain amount of the couple's combined resources is protected for the spouse living in the community. Depending on how much of his or her own income the community spouse actually has, a certain amount of income belonging to the spouse in the institution can also be set aside for the community spouse's use.
Following is the minimum and maximum amount of resources and income that can be protected for a spouse in the community in:


Assets: $128640


Minimum Monthly Maintenance Needs Allowance: $2114


Maximum Monthly Maintenance Needs Allowance: $3216

There are only 3 Payment Options for Nursing Home Long Term Care!

 

  • Privately paying from personal assets and income.
  • Long Term Care insurance if purchased prior to the need.
  • Florida Long Term Care Nursing Home Benefits (Medicaid Institutional Care Program)

 

The state of Florida Medicaid guidelines provide Minimum Monthly Maintenance Needs Allowances and Maximum Monthly Maintenance Needs Allowances for the Community Spouse. The term "Allowances" refers to the amount of income the Community Spouse is allowed to keep when the Nursing Home patient's income is added to the Community Spouse's income.

Click the link below to find out how much income the spouse may receive from the nursing home patient.

Calculate Community Spouse Diversion



The short answer is, almost every expense associated with room, board, and healthcare when associated with long term care in a nursing home.

A more thorough answer is:

The Florida Medicaid program provides medical coverage for Florida residents who meet the program’s eligibility requirements. Once an individual is approved for Medicaid in Florida medical bills will be paid, primarily by Medicaid although Medicaid is always the payer of last resort.  In other words, if there is other potential payers (i.e. Medicare, private insurance, V. A. benefits, etc.) then those sources pay first and Medicaid covers the balance.

The bills covered include not just nursing home care, but also hospital stays, home health care, home and community based services, hospice, transportation, dental and vision care, community behavioral health, and prescription medications. (Although in some cases, Medicare coverage may overlap this coverage).

The following services are required to be offered by all states, including Florida, under Medicaid:

  • Nursing facility services for individuals age 65
  • Nursing facility services for individuals 21 or older if determined disabled
  • Home health care for individuals that are eligible for nursing facility services
  • Inpatient hospital services
  • Outpatient hospital services
  • Physician services
  • Medical and surgical dental services
  • Lab and x-ray services
  • Family nurse practitioner services

The following services are optional; however, most states, including Florida will offer them through Medicaid:

  • Ambulatory services to individuals who are entitled to institutional care
  • Home health services to individuals who are entitled to nursing facility services
  • In-home assistance
  • Prescription drug coverage
  • Dental services
  • Prosthetic services
  • Optometrist services and eyeglasses

Transfers of income or assets may affect eligibility. If income or assets are transferred for less than fair market value to become Medicaid eligible, a period of ineligibility may exist for the individual. This will vary depending on the value of the transferred income or asset(s). Anyone determined ineligible due solely to transferred income or assets cannot qualify for nursing home payments. However, the individual may still qualify for basic Medicaid coverage (e.g., medicines, hospital coverage, etc). 

Allowable Transfers: 
Certain transfers are allowable. The individual may transfer: 

  • Any resource to a spouse or disabled adult child.
  • The homestead, without penalty, to one of the following relatives:
    • His/her spouse. 
    • His/her minor child (under 21 years) or his blind or disabled adult child.
    • His/her sibling who has equity interest in the home and resided there at least one year prior to the individual’s institutionalization.
    • His/her son or daughter who resided in the home for at least two years immediately before institutionalization and who provided care that delayed the individual’s institutionalization. 
Other transfers are evaluated case by case. 

If you're in a SNF, there may be situations where you need to be readmitted to the hospital. If this happens, there's no guarantee that a bed will be available for you at the same SNF if you need more skilled care after your hospital stay. Ask the SNF if it will hold a bed for you if you must go back to the hospital. Also, ask if there's a cost to hold the bed for you.

People with Medicare are covered if they meet all of these conditions:

 

 

  

     

    • You have Part A and have days left in your benefit period.
    • You have a qualifying hospital stay. 
    • Your doctor has decided that you need daily skilled care given by, or under the direct supervision of, skilled nursing or therapy staff. If you're in the SNF for skilled rehabilitation services only,    your care is considered daily care even if these therapy services are offered just 5 or 6 days a week, as long as you need and get the therapy services each day they're offered.
    • You get these skilled services in a SNF that's certified by Medicare.
    • The Nursing Home stay occurred within 30 days of the discharge from the hospital.
    • If the patient was previously on Medicare coverage for a Nursing Home stay of 100 days, the patient MUST have been back at home for a minimum of 60 days to qualify for another stay covered by Medicare.
    • You need these skilled services for a medical condition that was either: 
    • A hospital-related medical condition.
    • A condition that started while you were getting care in the skilled nursing facility for a hospital-related medical condition. 


Your doctor may order observation services to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged. During the time you're getting observation services in the hospital, you're considered an outpatient—you can't count this time towards the 3-day inpatient hospital stay needed for Medicare to cover your SNF stay. Find out if you're an inpatient or an outpatient.


    • If your break in skilled care lasts more than 30 days, you need a new 3-day hospital stay to qualify for additional SNF care. The new hospital stay doesn’t need to be for the same condition that you were treated for during your previous stay.
    • If your break in skilled care lasts for at least 60 days in a row, this ends your current benefit period and renews your SNF benefits. This means that the maximum coverage available would be up to 100 days of SNF benefits. 

It is important to point out that 100 days of Medicare coverage IS NOT GUARANTEED! Coverage can end at ANY TIME if the patient is deemed to have "plateaued" in rehabilitation without a reasonable expectation for improvement. 

Medicare will pay up to 100 days of care at the following percentages:

 

  • 100% of the rehab bill for the first 20 days if the patient continues to show the potential for improvement related to the rehab.  
  • 80% of the rehab bill days 21 - 100 if the patient continues to show the potential for improvement related to the rehab. If the patient DOES NOT have a secondary health insurance plan, the patient will be responsible for the remaining 20% as a co-payment ($164.50 per day) unless qualified for Medicaid and even then will be required to pay the Patient Responsibility portion required by Medicaid.
Many seniors enter the Nursing Home enrolled in Medicare Replacement Plans; typically HMOs. These plans are issued by either private or publicly traded companies. While these plans can be very helpful in reducing a senior's health care coverage premiums in the community, they can be very aggressive in the determination of when rehabilitation coverage will end. The goal is cost reduction by limiting the number of days of coverage. For this reason, many Nursing Homes will suggest that the patient dis-enroll from these HMOs and re-enroll in Medicare Part A. In most instances, Medicare Part A will allow the patient to retain rehabilitative coverage longer than Medicare Replacement Plans. Please consult with your Medicaid Attorney to find out if it is in YOUR loved one's best interest, not the Nursing Home's or the HMO's best interest, BEFORE making ANY changes to your Medicare/Medicare Replacement Plan coverage.

Frequently Asked Questions


What is Medicaid Institutional Care Program (ICP)?

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Who may apply for Nursing Home Medicaid?

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Can I qualify for Nursing Home Medicaid if my Income is over the limit?

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What are Medicaid Asset Limits?

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How long does it take to get Medicaid?

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