In Florida, Medicaid is the government program to help with medical expenses for the elderly, disabled and others. Many different types of Medicaid programs exist and the benefits are different depending on the particular program.
Florida has two main Medicaid programs to help pay for long-term care costs: Nursing Home Medicaid (ICP Medicaid) and Home/Assisted Living Medicaid (HCBS Medicaid). This article is being written to highlight the differences, and similarities, between the two programs.
Similarities Between ICP Medicaid and HCBS Medicaid
Generally, the income and asset requirements are the same for both programs:
- There is the same income cap for the Medicaid applicant
- There is the same asset levels for both programs
- Both applications go through the Department of Children and Families (DCF)
- Transfer penalties exist on all long-term care Medicaid programs (the 5 year look-back period)
- There are legal ways to protect assets within the 5 year look-back period
- Both programs are designed to help with the costs of long-term care for those in need
Differences Between ICP Medicaid and HCBS Medicaid
The differences between the two programs are very important:
- When you Apply for Medicaid
- You can apply for ICP Medicaid only when you are in the nursing home/rehab
- Most, but not all, of the times people enter the nursing home is after a 3 day hospital stay
- You can apply for HCBS Medicaid only after the applicant's name comes off the Medicaid Waitlist
- In this case, it does not matter where the applicant is when they apply (i.e., at home or in the ALF)
- You can apply for ICP Medicaid only when you are in the nursing home/rehab
- Who accepts Medicaid
- ICP Medicaid: Most SNFs (Skilled Nursing Facilities a/k/a nursing homes) accept Medicaid
- In Pinellas County, Florida, for instance. 100% of the SNFs accept Medicaid
- HCBS (ALF) Medicaid: Many assisted living facilities accept Medicaid, but not all
- In any event you will want to check with any facility to see if they accept Medicaid
- ICP Medicaid: Most SNFs (Skilled Nursing Facilities a/k/a nursing homes) accept Medicaid
- How Medicaid Pays
- When you are in the nursing home, ICP Medicaid basically pays for everything (all medical costs and room and board).
- A single person must pay their income to the nursing home minus $160.00 they keep in their personal needs allowance. This is known as the patient's responsibility.
- A married person - if there is a spouse at home, the amount that must be paid to the nursing home will vary based upon the community spouse's income. I have more about spousal diversion on this webpage.
- On HCBS Medicaid:
- If you are home, you get to keep your income.
- If you are in assisted living, Medicaid does NOT pay for all costs. Medicaid provides for a subsidy to the assisted living facility of about $1,500/m, although this will vary between facilities. The patient is still responsible for the room and board rate to the ALF. Here is an example:
- Mom has dementia and needs a secure assisted living facility. Her income is $2,500/m. The dementia ALF normally costs $7,000/m. This ALF accepts Medicaid. With Mom on Medicaid, she joins an MCO (Managed Care Organization). The MCO basically helps pay the medical portion only to the ALF, which is typically some $1,500/m. This means that the ALF bill will now be $5,500/m. If the family wants Mom to stay in this ALF, the family will have to pay $3,000/m out of pocket to keep Mom in the ALF. (her income of $2,500 + $3000 (family help) equals $5,500).
- With this, the personal needs allowonce that is given in ICP Medicaid does not really apply to HCBS Medicaid.
- Summary of the Difference in Pay:
- Our government (i.e., Medicaid) guarantees a nursing home bed for you if you run out of money and need 24/7 nursing care. The only cost for you to be in the nursing home may be your income. The government does not, however, guarantee a place in assisted living where Medicaid pays for everything. The ALF may bill you for more than your income, so the family will either need to:
- help pay for any extra costs; or
- find a cheaper assisted living facility.
- This also means that protecting assets as part of Medicaid spend-down planning may be even more helpful.
- Medicaid/asset protection planning is both legal and advisable in many situations in order to make money lasts for as long as possible.
- Our government (i.e., Medicaid) guarantees a nursing home bed for you if you run out of money and need 24/7 nursing care. The only cost for you to be in the nursing home may be your income. The government does not, however, guarantee a place in assisted living where Medicaid pays for everything. The ALF may bill you for more than your income, so the family will either need to:
- When you are in the nursing home, ICP Medicaid basically pays for everything (all medical costs and room and board).
We Can Help!
If you or your loved one is going through long-term care issues, our law firm can help, no matter where you live. We charge a $200 office consultation with an attorney to review your situation, your finances, your power of attorney, and then see if you need legal assistance in this difficult time.
Also, feel free to download my book, Your Guide to Florida Long-Term Care Medicaid.
