When you or a loved one need long-term care benefits provided by Medicaid, you have to pass several tests to qualify. You will first undergo a medical-necessity test to verify that you actually need long-term care during your application process. This usually requires your doctor to certify that the assistance you’re applying for is necessary to manage your daily living functions.
The other two tests you have to pass are the Medicaid Asset Limits Test and Medicaid Income Limits Test. Both of these examine your assets, your spouse’s income, and what your own gross income is when applying and for the previous five years (the lookback period). It’s important to remember that both of these tests consider your gross income, not your net take home. Some revenue categories are considered exempt and non-exempt, but determining which applies to your different assets can be confusing.
A knowledgeable elder law attorney is your best resource for determining which of your assets count against your eligibility and which do not. Still, some income sources have been clearly categorized as countable by the Medicaid program.
For veterans who receive VA Pension with Aid & Attendance, these benefits don’t count as income according to Florida guidelines for Medicaid eligibility. Also, suppose you are receiving social security income or any financial support from the below sources. In that case, these can be included when determining your long-term care benefit eligibility:
The good news about rental properties is that only your net income will go into the calculations for your Medicaid eligibility. So, you can still take advantage of deductions for related expenses like the percentage paid to your property manager, lawn care costs, etc. But, remember, the fact the IRS allows you to deduct some of these costs on your yearly tax filing doesn’t mean Florida’s Department of Children and Families won’t include them as part of their assessment. Speak with a qualified elder law attorney familiar to find out more about how your assets and income sources could affect your eligibility for long-term care benefits.
So, you may be wondering how these counted assets are applied in the Medicaid Asset and/or Income tests. Below is a brief overview of different applicant categories and how eligibility is determined.
For individual long-term care Medicaid applications, how DCF counts their income is fairly straightforward. To determine if an applicant falls within the imposed caps and guidelines, their total income will be added up. If that final sum is under the monthly Medicaid income limit, they are considered income-eligible. For those who exceed this cap, they are not.
Married seniors who are both applying for benefits will face a more complicated test process. This is because their income will be counted according to which program each applies for. Further, Florida treats each spouse separately, which gives each spouse the ability to have income up to the mandated limits.
Many times, married seniors will be in a situation where one spouse needs care while the other does not and can remain in the home living unassisted. To determine one’s eligibility in this scenario, DCF will only consider the income of the applying senior. The partner who isn’t applying is regarded as a community spouse under Florida law, and their revenue won’t be counted toward that of their loved one needing institutionalization.
If your income exceeds the income limits for long-term care benefit eligibility, this doesn’t mean you’re disqualified automatically. Florida has many legal options to help you still qualify for the care you need.
Qualified Income Trust
Also known as a Miller Trust, QITs are a type of irrevocable trust that, once formed, cannot be modified or revoked. This option allows you to put your income into a QIT, and your chosen trustee will control it. These funds will no longer count toward your income eligibility for Medicaid but can only be used for strictly outlined purposes.
Medicaid Spend Down Plan
The cost of a loved one’s care in a nursing home can easily surpass $10,000 a month in the Sunshine State. So to avoid an institutionalized senior’s assets disappearing quickly, careful spending of their money needs to be planned for ahead of time.
Some rules that affect the use of a Medicaid spend-down plan include:
Protecting your assets is crucial to ensure your care and needs are met adequately. Working with a reputable Florida elder law attorney can help you create an asset protection strategy to achieve this goal while protecting eligibility.
The Florida Medicaid Planning & Elder Law Firm has assisted many Florida families in setting up qualified income trusts and developing effective Medicaid spend-down plans. If you or a loved one needs long-term Medicaid soon, we can help you get finances prepared.
Call 954-999-9683 to schedule your strategy session today. If your elder is a Florida resident and needs long-term Medicaid, we can help, regardless of where you or the elder resides. We have completed thousands of successful Medicaid applications, and we would be glad to help you and your family in this likely difficult time.
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