THIS WEEK: Free Online Workshops on Estate Planning and Medicaid Planning. REGISTER NOW
THIS WEEK: Free Online Workshops on Estate Planning and Medicaid Planning. REGISTER NOW

Activities of Daily Living and Medicaid Eligibility

Activities of Daily Living and Medicaid Eligibility
Medicaid Planning
Jason Neufeld
March 26, 2020

Activities of Daily Living (ADLs)

There are six standards of Activities of Daily Living (referred to as ADLs). They include whether the Medicaid applicant can do the following six activities:

The first three activities of daily living refer to functional activities:

  1. Dress themselves
  2. Walking
  3. Transfering (e.g. go from sitting to standing, and vice versa) and maneuver to a chair or to their bed

The next three activities of daily living refer to activities necessary for hygiene and sustenance:

4. Bathe/Shower themselves.

5. Feed themselves (food and fluid intake)

6. Use a toilet themselves (maintaining continence, including taking care of a catheter or colostomy bag, or chancing a disposable incontinence product if person is unable to control bladder or bowel functions)

If the Medicaid applicant can do all six activities of daily living, they would not be considered in need of care and would be rejected from the program. 

If the Medicaid applicant has great difficulty with only one out of the six activities of daily living, they would qualify for the lowest level of care: “adult care.” 

If the Medicaid applicant was unable to perform two out of the six ADLs, they would qualify for a medium level of care: “assisted living.” 

If the Medicaid applicant required assistance with three out of the six ADLs, their condition would be deemed to require “nursing facility level of care” - the highest level of care.

A doctor’s diagnosis of “severe dementia” will also qualify a Medicaid applicant for nursing facility level of care.

Instrumental Activities of Daily Living (IADLs)

Instrumental Activities of Daily Living (or IADL / IADLs) refer to other important functions necessary to function independently.

IADLs include:

  1. Grocery shopping
  2. Laundry
  3. Light housework
  4. Meal preparation
  5. Medication Management
  6. Money Management
  7. Personal Hygiene (e.g. shaving, brushing teeth)
  8. Transportation
  9. Using telephone to take care of essential tasks (e.g. paying bills, setting up medical appointments, communicating with family)

How Florida Medicaid Looks at Activities of Daily Living - ADLs

Florida Medicaid will only pay for those who need nursing facility level of care (three or more impaired ADLs). Those who require a lower level may be able to obtain assistance through a Medicaid waiver or Medicaid diversion program.

In order to qualify for Medicaid, the DCF caseworker is checking to see if the Medicaid Institutional Care Program (ICP) applicant meets the Medicaid eligibility standards. There are three broad tests:

Medicaid Asset Test: The Medicaid applicant must have $2,000 or less in countable assets (certain assets are exempt and will not be counted toward the Medicaid resource limits)

Medicaid Income Test: The Medicaid applicant must gross less than $2,829.00 per month in income from all sources (e.g. social security, pension withdrawals,annuity payments, investment income, and wages) as of 2024.

You should talk to an elder law attorney / Medicaid planning attorney to discuss ways to legally and ethically qualify you or your loved one for Medicaid.

Medicaid Needs Test

After the income and asset standards are met, there must be a medical need for Medicaid’s long-term care services (referred to as ICP). Before being admitted into a nursing home (under the Medicaid ICP program). The Department of Elder Affairs representative will conduct a Comprehensive Assessment and Review for Long Term Care Services. This is also referred to as a CARES Assessment or the CARES Program.

How does the CARES program evaluate activities of daily living? 

CARES conducts a pre-screening program to review the “level of care” required for a nursing home applicant or for someone looking for home and community-based services (such as through the Adult Cystic Fibrosis Waiver, AIDS Care Waiver, Traumatic Brain Injury/Spinal Cord Injury Waiver, Familial Dysautonomia Waiver or Florida Managed Care Long-Term-Care Program). This Waiver program will also pay for some home health care (the hours approved depend on the applicant's ability or inability to conduct their activities of daily living; and a portion of an ALF bill.

Once someone applies to the Medicaid ICP or waiver program, a CARES assessment will be triggered.  

The CARES Assessment will be evaluating the Medicaid applicant’s ability to perform their typical activities of daily living. Part of our service is to coach our client's (or their designated representatives) through the screening process to get Medicaid benefits started as quickly as possible.

Florida Elder Care Attorney Resources

How does CARES score and prioritize Medicaid applicants?

Statewide Medicaid Managed Care Long-Term Care Program Coverage Policy

Jason Neufeld

Jason Neufeld is the Founder and Managing Partner of Elder Needs Law, a Florida estate planning and elder law firm he created in 2017. With more than 15 years of experience practicing law, he represents clients in a wide range of legal matters, including Medicaid planning, estate planning, elder law, probate, Medicare, and life insurance.

Jason received his Juris Doctor from the University of Miami — School of Law and is a member of the Florida Bar and the Broward County Bar Association. He has received numerous accolades for his work, including being named a Rising Star and Super Lawyer by Super Lawyers and among the Florida Legal Elite by Florida Trend in 2024.

LinkedIn | State Bar Association | Avvo | Google

Related Post