Understanding The Maze of Florida's Long Term Care Medicaid Programs
Isenhour Senior Services
May 22, 2024
Florida - Southwest
Email US
Click to Email Us
As a Certified Senior Advisor
specializing in Medicaid representation in Florida, our staff goes breathless
attempting to explain the differences between the various long term care
Medicaid programs offered here in Florida.
In this article, I will attempt to cover as many aspects of these
programs as possible and assist you through this maze of confusion.
Long Term Care Programs:
1. ICP - Institutional Care Program (Nursing
Home Medicaid) – This program is the one
that most of the inquiries to our office are calling about. ICP is for nursing home residents who need assistance
in paying the high cost associated with this level of care. The private pay cost of this type of care can
range anywhere from $9,000 to over $15,000 per month. This program is for those who possess a need
of assistance with at least 3 activities of daily living (bathing, dressing,
toileting, transferring, feeding oneself) or are a hospice patient in addition
to residing in a skilled nursing facility.
2. Hospice - For individuals with a life
expectancy of 6 months or less. While Hospice services are primarily
covered by Medicare, if a person resides in a nursing facility and are applying
for Medicaid, hospice would assist in managing the care even in the nursing
facility.
3. HCBS - Home and Community Based Services
(Waiver programs)
A. Hope Pace - All-inclusive medical program
that assists people who are living independently. The individual is expected to use the medical
professionals that Hope Pace contracts with and recipient would attend their
health center at least one day per week to see doctors there. Transportation is provided in addition to
many other benefits. This program provides supportive services in order to
allow the applicant to maintain their independence and the goal is to avoid
placement for as long as possible. Hope
Pace is a pilot program and not available in all counties. For more information, their phone number is
239-985-6400.
B. Medicaid Waiver for care at home, daycare or in
an Assisted Living Facility-These programs are funded and have a waiting list
which is managed by a State agency called the Area Agency on Aging. Each person who calls to be added to the
waiting list is given a phone assessment appointment to be called by the agency
at a later date and asked a series of questions. The phone assessment takes
about 45 minutes and afterward the recipient is given a priority score based on
physical need for care and is placed on the list based on their priority score.
Those with the most need for assistance with activities of daily living are
given a higher priority score than others with less need for physical help. The
goal is to avoid nursing home placement, so those at a higher risk of possible
nursing home placement are moved to a higher position than those that are more
independent. They will usually ask
financial questions as well during the phone assessment. Phone number for Area
Agency on Aging is 239-652-6900.
Qualification and Procedure:
All long-term care Medicaid programs have the same income
and asset limitations. The applications
are submitted using an online portal through the Department of Children and Families
(DCF). You may also fax in a paper application to the department, but
submitting online gives access to information much more efficiently than
waiting for notifications to come via U.S. Mail. Since you would be using the
online portal, you may log in whenever you would like to check on your case and
the online portal allows changes to be reported more easily and notices may be
viewed upon generation. This application
process is comprehensive in terms of all financial aspects of the applicant’s
situation in order for the caseworker to determine eligibility.
The Medicaid
applicant income limit is currently $2,829 per month and increases each year commensurate
with Social Security cost of living adjustments. The individual’s gross income is what is counted
which is the amount prior to any deductions such as Medicare or other health
insurance premiums, tax withholding, union dues, life insurance premiums,
etc. If the applicant’s gross countable
income exceeds the limitation, they would need to obtain the assistance of an
elder law attorney to provide a remedy. Isenhour
Senior Services is not a law firm, but would be able to offer a list of
competent attorneys to contact for the purpose of legal needs as they arise.
Allowable assets may include Florida homestead
with a maximum value of $713,000 for a single individual and unlimited value if
a spouse or minor child is living in the home; other income producing real
estate that is producing fair market value income (net income after calculated
expenses is counted as income); additional property that is listed for sale at
fair market value; vehicle of any value; IRAs if there is an income distribution
in place; Irrevocable funeral arrangements of any value; An additional $2,500
in other burial funds which can be in the form of savings, life insurance cash
value, or other assets that the value can be verified; and up to $2,000 in
other liquid or non-liquid assets.
For nursing home Medicaid applicants, if there is a spouse
living in the community, the community spouse’s resource limit is $154,140 in
addition to the previously mentioned items.
For nursing home applicants, there is usually a dollar amount that is to
be paid from their income called a patient responsibility. The patient responsibility is paid to the nursing
home and Medicaid pays the remaining balance of the charges. The applicant is allowed to keep $160 for
personal needs and enough to cover any medical premiums such as dental or
health insurance, hearing aid leases, etc..
When there is a community spouse living at home or in a
private pay assisted living facility and their ill spouse is applying for nursing
home Medicaid, their information is also included in the applicant’s
application for benefits and the community spouse may possess the ability to
retain some of the applicant's income in order to meet their shelter expenses
in the community. Currently the State of
Florida allows the community spouse to retain a minimum of $2,465 from both
spouse's income sources in order to meet their needs in the community. If the spouse has excess shelter costs, such
as assisted living expenses, mortgage, rent or other high shelter expenses,
they are allowed to keep more of the applicant's income, with a maximum total
income allowance of $3,854 per month. This
amount includes both spouse’s gross monthly income. If the community spouse needs even more than
this amount to cover their expenses in the community, they may wish to seek
legal advice for a court order for spousal support.
For the Assisted Living Medicaid Waiver program, once the
applicant’s name has come up on the Area Agency on Aging’s waiting list and the
application is submitted and approved (usually a 60-day time period), then
benefits begin the following month. The Medicaid recipient would then need to
choose a managed care provider which would be the one that the facility they
are preferring accepts. That provider would
contribute up to somewhere between $1300 and $1600 per month toward the charges
after the recipient has contributed their income minus allowances. The rest of the ALF’s charges would still need
to be paid so that the facility still receives full payment. If the recipient’s income is not sufficient
to cover the remaining charges and the family cannot cover the shortfall, the recipient
may need to enter a nursing home if they qualify physically for that level of
care, since nursing home Medicaid only expects the applicant to pay in less than
their monthly income as their patient responsibility. This same Medicaid Waiver program can assist
with homecare hours and other services which would help them to remain in their
home if that is a safe decision.
For all long-term care programs other than Hospice, there is
a physical level of care evaluation that is completed by the Department of
Elder Affairs which would determine if the individual meets the physical need
of the program for which they are applying.
This evaluation is requested by sending a 3008 form that has been
completed and signed by the individual’s physician along with additional
medical records including medication list to the Department of Elder
Affairs. An assessor would then make
arrangements for an evaluation to be performed wherever the individual is
residing. The final report is then
provided to the Department of Children and Families, and added to the financial
documentation already sent in by the applicant and then the DCF caseworker is
able to open the benefits for which the applicant had applied if all
qualifications have been met.
If the individual had applied for nursing home Medicaid, the
effective date of the Medicaid approval would be the 1st of the
month that the application was submitted, providing the individual was eligible
beginning in that month. The waiver
programs are forward-moving programs in that benefit begins the 1st
of the following month after approval is granted and enrollment in a Medicaid managed care plan. The plan that is chosen would provide a case
manager who would contact the recipient and/or family to discuss the applicant’s
needs and plan of care. The case manager
would also remain involved in the client’s ongoing care needs.
In order to continue ongoing benefits, the applicant must
submit a renewal of benefits each year with the Department of Children and Families
and is also responsible for reporting any changes that occur along the way, such as changes in living arrangements, income,
expenses, assets, etc. The physical
level of care evaluation does not need to be repeated each year, only the
financial piece.
So, as you can see, the web of confusion that is created by
Florida’s Medicaid long term care system is forever in need of explanation. What I have provided here is a plethora of
information to comprehend and we are here for you to help you through this maze.
Christine Isenhour
President
Isenhour Senior Services
239-542-7366
Other Articles You May Like
Dietary Changes as We Age
Dietary needs evolve as people age, and seniors need to know how to manage those changes to maintain physical health and wellness. Older adults need to take an active role in shaping their diet and nutrition habits to ensure more energy, better disease prevention and quality of life.Seniors should consult their physician to discuss their individual needs. Healthcare professionals can also help seniors and their families create and implement healthy eating plans.These plans often include:Increased protein and fiber intake. Protein and fiber are important nutrients for seniors. Foods high in fiber can help maintain healthy digestive systems as we age, and increasing protein intake can help seniors increase or maintain energy and strength. Whole grains have multiple benefits. Whole grains are also fiber-rich foods that not only aid the digestive process but promote healthy hearts for seniors. Cereal, rice and bread made with whole grains can easily be found at any grocery store and provide several serving choices to meet recommended daily requirements.Calcium is a key component in maintaining bone strength. Calcium can help prevent osteoporosis, especially when calcium intake is consistent. Preventing osteoporosis is critical for seniors especially those that are at risk for falls.Hydration is critical at any age. Physical changes that occur with age make hydration even more important for older adults. For those that are less inclined to drink water, there are alternatives milk, juice and broth are all hydrating liquids, and there are hydrating foods including watermelon, cucumbers and grapes. If engaging in good eating habits is a struggle, there are steps seniors can take to ensure that they are getting proper nutrition. In addition to consulting a physician about diet or health concerns they might have, they can also try the following tactics to get back on the right track:Make meals a social occasion Sharing a meal is one of the most enjoyable ways to ensure that someone is eating well. This can include making something healthy and delicious for others, or reaching out to people that love to cook healthy food and offering them some company at meal times.Make healthy eating fit your budget Good food doesnt have to be expensive. A doctor or nutritionist can point patients to budget friendly, nutritious food options. And, maintaining a healthy lifestyle saves money on medical care in the future.Shop for healthy foods Having a kitchen stocked with healthy snacks and meal options is one of the most important steps to maintaining a balanced diet. Encourage people to ask for help If someone has concerns about their ability to plan healthy meals, shop for the groceries or if they just arent getting the nutrition they need, tell them to ask for help! In-home caregivers, delivery services, family, friends and medical professionals can all help older adults reach their nutrition goals.Comfort KeepersCan HelpIf someone is struggling to maintain healthy eating habits, consider getting support from the trusted care team at Comfort Keepers. Our caregivers can help with grocery shopping, meal preparation, and can help support physician-prescribed exercise regimens and diets. Our goal is to see that clients have the means to find the joy and happiness in each day, regardless of age or acuity.To learn more about our in-home care services, contact your local Comfort Keepers location today.References Mayo Clinic. Senior health: How to prevent and detect malnutrition. Web. 2017.Next Avenue, Malnutrition is Affecting Too Many Older Adults. Web. 2016. Public Health Post. Malnutrition in Older Adults. Web. 2017 Healthline. How Your Nutritional Needs Change as you Age. Web. 2017.
Embracing Pickleball's Benefits: A Game-Changer for Seniors' Health and Well-being
As we age, staying physically active becomes essential for maintaining a healthy lifestyle and enjoying more vitality and well-being. Fortunately, there is a sport that has gained popularity among seniors in recent yearspickleball. Pickleball combines elements of tennis, badminton, and table tennis, offering numerous benefits for older adults. From improving cardiovascular health to fostering social connections, this low-impact sport has proven to be a game-changer for seniors seeking an enjoyable and accessible way to stay fit. Let's delve into the world of pickleball and explore the benefits for older individuals. Low-Impact Exercise One of the most significant advantages of pickleball for seniors is its low-impact nature. Unlike high-impact sports like running or basketball, pickleball places less stress on joints, reducing the risk of injuries and joint pain. The game is played on a smaller court, requiring less lateral movement and putting less strain on the knees, hips, and ankles. The low-impact nature of the game makes pickleball an ideal choice for seniors with arthritis or those recovering from joint-related surgeries.Furthermore, the game's slower pace allows seniors to build endurance gradually while engaging in a moderate-intensity workout. Combining aerobic and anaerobic movements in pickleball enhances cardiovascular health, lowers blood pressure, and strengthens the heart. Regular sessions help seniors improve their overall fitness levels, stamina, and balance, reducing the likelihood of falls and enhancing their independence. Social Interaction and CommunityPickleball is more than just a sport; it's a social activity that fosters connections among seniors. Many communities and retirement centers now offer pickleball facilities, bringing people together to play and socialize. The game's doubles format encourages teamwork, communication, and camaraderie, making it an excellent opportunity for seniors to meet new people and develop lasting friendships. Playing pickleball promotes a sense of belonging and community involvement, which can combat feelings of loneliness and isolation. Seniors who participate in pickleball leagues or join clubs often report increased happiness and improved overall quality of life. Cognitive BenefitsPickleball isn't just a physical workout; it also offers numerous cognitive benefits for seniors. The game requires strategy, quick thinking, and hand-eye coordination, stimulating the brain and promoting mental agility. Regular pickleball play can enhance cognitive function, memory, and problem-solving skills, reducing the risk of age-related cognitive decline. Moreover, pickleball provides a unique opportunity for seniors to engage in continuous learning. Whether learning new techniques, refining their shots, or adapting their gameplay, seniors can continuously challenge themselves and expand their skill set. This mental stimulation contributes to maintaining a sharp mind and a sense of accomplishment. Pickleball has emerged as a beloved sport for seniors, offering many benefits for their physical, social, and cognitive well-being. The low-impact nature of the game allows seniors to remain active without putting excessive strain on their bodies. The social aspect of pickleball fosters a sense of community and combats social isolation. Additionally, the cognitive demands of the game help seniors stay mentally sharp and agile. So, whether you're a seasoned player or a beginner looking for a new hobby, consider embracing pickleball as a game-changer for your overall health and happiness in your golden years. Get on the court and start experiencing the remarkable advantages of pickleball today! Comfort Keepers Can HelpCaring for others and ourselves can take a lot of thought and preparation as we age. Our Comfort Keeperscan help encourage seniors to meet activity guidelines, recommend ways to add more physical activity to their day, and can help to motivate a senior to stay active. Our trained caregivers can provide transportation to a local park, a trail, or greenways to enjoy a walk together or watch a pickleball game. Caregivers can drive clients to scheduled doctor appointments, provide mobility assistance and meal preparation, and help with activities of daily living. We believe in Elevating the Human Spirit by providing our clients with practical assistance and daily moments of joy. By giving equal parts compassion, attention, and comfort, our goal is to help seniors feel independent again while promoting good health to enjoy their days. ResourcesNational Library of Medicine (NIH): Pickleball: Injury Considerations in an Increasingly Popular SportAmerican Institute for Preventive Medicine: What can the Well-Being Industry Learn from Pickleball?Medical University of South Carolina: Pickleball: Fastest Growing Sport Especially for Seniors
How to talk to your siblings about senior care
Caregiving can be a rewarding experience, and an opportunity to give back some of the care and compassion received earlier in life. As we watch family members age, it can bring up big emotions and challenges. It's hard to see an aging parent loved ones growing older and in need of help. Especially when it comes to having the initial conversation about options like in-home care. Having that first conversation about a loved one and their needs can be challenging, but it should be done sooner rather than later. As a person ages, their ability to make decisions may diminish. For a decision as important as this one, everyone in the family should feel heard. Steps for a Successful Family Care Conversation Step 1: Plan the ConversationAs the saying goes, seeing is believing. Phone calls don't always convey the complete picture of the situation. How can your family make this easier? Try to pick a date and time when you can get the whole family together and in person for this vital conversation. If its impossible to get your family together in person, a video call can be a great alternative. Try not to wait for an accident or medical emergency before addressing the future after all, it is always harder to think clearly and make decisions in moments of crisis. There are many different options for in-home care, and information can help find a solution that is the best fit. Start your research to see what you think is best for you and your family. Step 2: Share concerns from a place of love Although this can be intimidating, staying calm and taking breaks is important. The initial conversation is to understand each other and begin to set goals together as a family. Have the necessary paperwork or documents to help everyone in the family. Share any stories or anecdotes from the older family members doctors or friends will be helpful as well. It's easier for everyone to understand the situation when medical records illustrate important care concerns. If the older member of the family expresses interest in staying in their home as they age, then in-home care may be the right choice for them. Seniors who use home care services report 25% fewer doctor's visits than those who do not. [AM1] Step 3: Talk it out Make sure you give everyone time to speak; everyone might not always agree during this process but respecting each other and staying level-headed is key. Ultimately a good rule of thumb is to ask a lot of questions. Ask siblings and family members for their thoughts and what they think about getting an aging parent in-home assistance, and ask the loved one their desires for this next step in life. What to do after the first conversation? Give it some time, and make sure everyone has collected their thoughts from the initial discussion. Every family is different. Don't feel discouraged if a few conversations are needed before everyone is comfortable moving to the next step. It can take some time for siblings and family members to come around; just remember to be patient and make sure everyone has a clear understanding of their role and responsibility in this decision. Here's a resource to help define the roles when moving forward. Comfort Keepers Can HelpComfort Keepers caregivers can help with encouragement, support, and assistance with daily living. Caregivers can encourage overall health through meal planning, grocery shopping, meal preparation, and activities. Our custom care plans focus on physical and mental health and wellness activities. Our goal is to see that clients have the means to find joy and happiness each day, regardless of age or understanding.To learn more about our in-home care services, contact your local Comfort Keepers location today.
Local Services By This Author
Isenhour Senior Services
Medicaid Planning 6835 Porto Fino Cir., Ste. 1, Fort Myers, Florida, 33912Our office helps nursing home patients and assisted living residents as well as people in their own homes apply for Medicaid benefits. We stand by our work by offering a money-back guarantee our fee returned to you if you are not approved for Medicaid due to an error on our part.Our office focuses specifically on Medicaid representation with over 20 years of experience in this field. Our knowledge and ability and 100% approval rating on nearly 90 cases a year speaks for itself as well as a close working relationship with Florida government social service specialists. *Our office prides itself on its integrity, approachability, and one on one personal service with references available at the highest level upon request.* We also continue in the role of Authorized Representative for the Medicaid recipient's lifetime, performing yearly reviews in order to continue benefits, as well as processing notification of changes along the way. The Medicaid recipient or their family will never have to deal with the Department of Children and Families.Our office specializes in helping nursing home patients and assisted living residents as well as people in their own homes apply for and get approved for Medicaid benefits.Discovery Organize Application Submission Upload & Approval Commitment to you as long as neededYearly Review