How to apply for medicaid for nursing home

Our law practice frequently deals with applying for long-term care Medicaid for our elderly clients. Medicaid can pay for a number of things such as nursing home, assisted living and in-home care. The long-term care Medicaid program has a number of rules and regulations and the application process is seldom, if ever, easy.

An applicant is not eligible for Florida Medicaid unless he or she meets certain asset and income limitations. Here, the Medicaid applicant must be:     

• At least 65 years of age or disabled;
• A United States citizen or a “qualified” alien;
• A Florida resident;
• Gross monthly income must not exceed $2,382/month (2021); and
• Countable assets for a single person must not exceed $2,000. Assets for a married couple allow the Community Spouse (the spouse not in long-term care) to have $132,380 (2021) in countable assets.

Financial Requirements

Medicaid long-term care benefits are only available to those individuals or couples who meet a complex list of requirements. There are many rules and exceptions to the rules. Financial requirements are divided into two separate and distinct categories: income and assets. These two particular requirements rarely interact with each other.  We have a current list of Florida Medicaid and VA financial requirements on this webpage.  Importantly, you cannot have given away money/assets within 5 years of a Medicaid application.

Income and Medicaid

The applicant’s gross monthly available income must not exceed $2,382/month (2021). Gross income is not the same as taxable income—Social Security taxes, Medicare Part B premiums, and employee portion of health insurance premiums, are not deducted from gross income.

If the applicant’s income exceeds the designated limit, a Qualified Income Trust (QIT) must be created and funded to facilitate Medicaid eligibility. This is one reason why a good, current durable power of attorney is necessary as you age.

The income of the spouse staying at home (the “community spouse”) is not included in determining benefits for the applicant. He or she can have unlimited income. However, if the community spouse’s gross income is below a certain level ($2,155/m until 06/21), the community spouse will be allowed to divert some of the applicant’s income for his or her own financial needs. This is known as the spousal diversion. You can learn more about spousal diversion here as the rules are very complex.

Assets and Medicaid

As Medicaid is a “needs-based” program, most individuals applying for benefits can only have $2,000 in countable assets. The community spouse is allowed to have $130,380 (2021) in countable assets at the time of application (jointly, $132,380). If both spouses are institutionalized and applying for Medicaid, only $3,000 in countable assets are allowed between them.

Assets may either be countable or non-countable for Medicaid purposes. The most important asset, the homestead, is not countable unless it exceeds $603,000 (2021) in value. There are a few other non-countable assets such as:

• Any one car of unlimited value;
• A second car if over seven years old and not a collectible car;
• Funeral plots;
• Irrevocable pre-paid burial policies; and
• Life insurance with face value less than $2,500.

Here is a link to our Medicaid planning homepage.

A jointly held bank account is a countable asset and is not divided among the owners. Regardless of whether a son or daughter was added to the account and has been funding it to pay the parent’s bills, the value of the account is all attributed to the applicant unless it can be proven otherwise.

When assets are over the legal limit, the family would consider legal spend down of assets and would likely consult an elder law attorney. There are many other rules, pages worth, and an amazing number of places where it is possible, or even likely, to make a disqualifying mistake. Legal advice is highly recommended if your assets exceed the bare minimum and you intend to apply for Medicaid.

How to Apply for Long-Term Care Medicaid

For those applicants who are already at or below the income and asset levels, it is very typical that the nursing home does the application for you/the resident.  Typically, the business office and/or social worker can do this when the resident's income and assets are already below the applicable limit. If you/the elder is at home and looking to apply for Medicaid, then you would call your local Aging Resource Center to get placed on the long-term care wait list.  There is no waitlist for nursing home Medicaid but there is a very long waitlist for assisted living and in-home Medicaid assistance.

If the elder's assets are above the minimum level, then it is highly likely that the family will want to consult a good elder law attorney to learn legal ways to protect assets. Here, the elder law attorney would do the application for the elder after assets are legally protected, when appropriate.

What about Assisted Living Medicaid or In-Home Care?

Assisted living or in-home Medicaid in Florida is very difficult to access. If the applicant's assets are less than the income and asset limit, this does not mean the applicant will get Medicaid to help pay for assisted living. There is a long waitlist to get Medicaid for assisted living care and we have no way of telling when or if the elder will come off the wait list. We have more on assisted living Medicaid and bypassing the assisted living waitlist here.

Can our Law Firm Help?

Regardless of where you are in the state of Florida, our law firm may be able to help protect assets and apply for Medicaid. We have been protecting assets to benefit the elder and their family for over 20 years and we have successfully completed thousands of Medicaid applications. We charge $200 for an hour long consultation with an elder law attorney who is glad to review your family's situation to see if we can help.

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Want to Learn More?

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• Long-Term Care Planning Options
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