Am I Eligible to Receive Long Term Care Services in Florida?
People need extra help as they age. It's natural, inevitable, and often challenging. Long-term care services can have a life-altering impact on your personal care. However, eligibility requirements can be complicated and difficult to navigate--especially when someone has already reached a state that will require them to receive long-term care.
Whether you are looking to secure future treatment for yourself or establish care for the elderly people in your life, it's best to get an early start. In this article, we look at the basic eligibility requirements for long-term care insurance, the part that Medicaid plays, and how an elder law attorney can help.
What is Long Term Care?
Let's first clearly define long-term care and how it differs from standard acute medical care. In the next several headings, we explore the various care program options.
Long Term Care Involves Ongoing Assistance
Long-term care refers to hands-on help and supervision over an extended period. It is implemented for people who require assistance with daily self-care activities.
For example, medication management, personal finance, and general home safety can all become more challenging for aging people who live at home. Toileting, changing clothes, feeding oneself, and bathing are some examples of activities of daily living. Ongoing home care to help an individual with their activities of daily living or instrumental activities of daily living may allow the person to remain safe while retaining as much independence as possible.
In other words, “long-term care” can be used to help someone stay at home longer or to help pay for a facility (when staying at home is no longer possible).
Long Term Care Differs from Standard Health Care
Standard acute medical care treats temporary illnesses or injuries. For example, if you get an infection, that's an acute illness. Once treatment is applied, you will no longer have the infection.
People who receive long-term care will often need it for the rest of their lives. Instead of diagnosing specific problems and working on eliminating them, the focus is on quality of life.
What Care Activities Qualify?
Hands-on assistance with qualifying Activities of Daily Living includes help with:
- Bathing
- Dressing
- Eating
- Transferring in/out beds and chairs
- Using the toilet
- Managing medications
Supervising someone with cognitive conditions like Alzheimer’s who requires oversight for safety also qualifies as hands-on custodial care.
In-home caregivers, assisted living communities, adult day centers, and nursing homes provide this long-term supportive care.
Eligibility Requirements for Florida Long-Term Care Services
To receive Long-Term Care (LTC) services through Florida Medicaid, individuals must meet certain criteria assessed by two state agencies:
Medical Eligibility
The Department of Elder Affairs (DOEA) determines medical eligibility via the CARES program. Requirements include:
- Age 65+ and eligible for standard Medicaid
Or
- Age 18+ and eligible for Medicaid due to disability
And
- Assessed to require either nursing home or skilled nursing facility-level long-term care for a variety of conditions or ailments.
Financial Eligibility
Additionally, the Department of Children and Families (DCF) analyzes finances to decide Medicaid eligibility. Considerations include income, asset levels, and ability to pay for long-term care privately. Applicants must demonstrate financial need through submitting tax returns, bank statements, medical bills, and other documentation.
Consulting with a Florida elder law attorney can help when exploring coverage options for long-term care. Our team guides clients through the needs assessment and financial qualification process while maximizing care access.
Does Medicaid Cover Long-Term Care Costs?
Medicaid provides healthcare coverage to qualifying low-income individuals. But strict qualification rules apply regarding both medical necessity and financial means tests to receive assistance with long-term care costs. In the next few sections, we look at what needs to be established as you apply for Medicaid long-term care.
Demonstrating Medical Necessity
You must have a doctor certify that you require assistance with multiple Activities of Daily Living as we defined above. For example, if you need help bathing, dressing, and taking medications properly, those could serve as your qualifications.
Cognitive conditions like dementia or Alzheimer’s warranting supervision for safety also qualify.
Income and Asset Limits
Beyond medical requirements, Medicaid imposes financial thresholds as well. Allowable income and asset limits adjust annually but tend to fall around:
- Monthly Income below $2,829.00 (as of 2024)
- Assets below $2,000 individually / $3,000 married, excluding certain home equity and personal property
Proving low enough income and assets (or "spending down" excess resources first) allows coverage once the necessity threshold is met.
Planning Early for Future Long-Term Care
Even if you don't currently qualify for public assistance or insurance programs, proactive early planning improves future preparation. Tactics to appropriately position your situation for Medicaid or other coverage in the future include asset relocation.
Here's a breakdown of what that looks like:
- Strategically converting countable assets within five years using a variety of Medicaid-compliant tools
- Making gifts to family or to Irrevocable Medicaid Asset Protection Trusts now per Medicaid rules for those who do not expect to need care within the next five years.
- Prepaying or buying exempt assets, e.g. burial contracts and life insurance to cover final expenses
Where possible, it helps to plan at least five years in advance. Consulting a Medicaid planning attorney before you need care can make it easier to manage your assets in a way that is conducive to future needs.
Please contact us to discuss your situation. We're happy to assess options and recommend responsible living, investment, and asset protection approaches to improve access to quality care when needs arise.
