What is Florida Medicaid?

Medicaid is a jointly funded program between the federal government and the individual states that provide medical assistance for those who are medically needy and who qualify financially. Since it is a jointly funded program, each state has different laws when it comes to Medicaid.

Medicaid in Florida refers to many health-related programs, such as health care for the disabled, the poor, and various other programs.

This article will cover the two main Medicaid programs for the elderly:

1. Florida’s Institutional Care Program (ICP Medicaid), and
2. Home and Community-Based Services (HCBS Medicaid).

What is the Difference Between Medicaid and Medicare?

Medicaid and Medicare are two completely different programs.

Medicare is a multi-part health insurance program that was created to help the elderly and the disabled. Medicare is not means-tested—meaning that assets and income do not matter when qualifying for Medicare—since Medicare qualification depends entirely on whether an individual over the age of 65 has worked enough to have paid enough credits into the Social Security system.

Medicare will only pay for 100 days of skilled nursing facility care if a number of criteria are met.

Medicaid is a means-tested program—this means that you must qualify both asset and income-wise. If you qualify for Medicaid, Florida Medicaid will pay for an unlimited amount of nursing home care.

How Does Someone Qualify for Medicaid? 

To qualify for Medicaid you must meet a three-part test:

1. You must be medically needy;
2. You must meet the asset test; and
3. You must meet the income test.

In order to be medically needy, the Department of Elder Affairs (CARES) will assess the level of care that you need to determine which program you qualify for.

For Medicaid to pay for the nursing home this means that an individual must require skilled, intermediate, or custodial care. Generally speaking, this means that CARES will assess whether you can perform the activities of daily living (ADLs):

1. Eating
2. Bathing
3. Dressing
4. Toileting
5. Transferring (e.g. getting out of bed without assistance), or
6. Maintaining continence.

If CARES determines that you are unable to perform or can’t significantly perform 4 out of the 6 ADLs listed above then you will qualify for nursing home Medicaid.

Florida Medicaid Asset Test

A Florida Medicaid applicant must also meet the asset test. This means that a single Medicaid applicant can only have $2,000 (2019) in assets in their name.

If the applicant is married and both the applicant and both spouses are applying for Florida Medicaid, then they are allowed $3,000 in assets.

Many of our estate planning clients immediately hear the word Medicaid and they think that they automatically do not qualify for Medicaid because they think Medicaid is a program only for those who cannot afford the nursing home. We then tell our clients that we could get even Bill Gates qualified for Medicaid.

While getting Bill Gates qualified for Medicaid may be a bit of a stretch, the reality is that even those with hundreds of thousands of dollars—even millions—can qualify for Medicaid. The reason is that some assets are considered exempt for Medicaid purposes (e.g. your Florida Homestead) and some assets are non-exempt (e.g. Jimbo and Delilah’s SunTrust Bank Account).

Florida Medicaid Income Test

The Medicaid income test is much more straightforward than the asset test. A Medicaid applicant can only earn $2,313 (2019) of income per month. If the applicant earns even a penny more—$2,313.01—then the applicant does not meet the income test for Medicaid and is disqualified.

Just like the asset test, the income test can still be met even if an applicant is above the allowed amount of income per month.