In order to qualify for Florida long term Medicaid (which pays for part of their home-health care, ALF care and all of their nursing home care, depending on the level of care needed), the applicant must satisfy three main eligibility tests. The first is the medical-necessity test - the Medicaid applicant must actually need the care. A doctor must certify that the Florida Medicaid applicant requires assistance with their activities of daily living.
The second and third tests one must pass in order to be considered eligible for long-term care Medicaid in Florida – and the subject of this article – are the Medicaid Asset Limits Test and Medicaid Income Limits Test. Both the asset and income tests must be met in order for one to become eligible to receive home health care, ALF or nursing home benefits. If you, or your loved one, do not currently pass the income test or asset test for Medicaid eligibility - an elder care lawyer who focuses on medicaid planning can be of great assistance.
Asset Limits for Florida Long-Term Care Medicaid
It’s important to note that there are different Medicaid programs in Florida. Some of which have higher asset limits. This article is only focused on the asset limits for those who need nursing home, ALF or home-health care.
Below, I’ll discuss a few different scenarios: (i) the asset limit test for a single person applying for Florida long-term care Medicaid benefits; (ii) the amount of assets a married couple can have if both are applying for ICP or Medicaid Waiver benefits; and (iii) the asset limits a married couple can have if only one needs either of the above-referenced long-term care Medicaid benefits.
Asset Limits for a Single Person Applying for Florida Medicaid Benefits
In order to qualify a single individual over the age of 65 (or disabled), who needs home-health aide, assisted living facility or skilled nursing home Medicaid benefits, he or she can have no more than $2,000.00 in what is considered countable assets for Medicaid. Luckily not all assets are counted (but most are). The linked article will discuss which assets are countable vs. which assets are not counted, i.e. deemed exempt, toward the asset test.
Importantly, joint bank and brokerage accounts are deemed 100% owned by the Medicaid applicant (not 50/50).
Joint real-estate assets will not be counted if (a) the other owners is not seeking Medicaid benefits and (b) they refuse to sell their share of the real estate thus making the Florida Medicaid applicant’s portion unsaleable.
Revocable Living Trust assets are deemed 100% countable against the Medicaid applicant when determining eligibility.
Medicaid Asset Limits for a Married Couple if Both are Applying for Florida Medicaid Benefits
If a married couple both wish to apply for Medicaid long-term care benefits, they can have no more than $3,000.00 in what Medicaid considers countable resources combined!
Medicaid eligibility is the most stringent and draconian for the married couple seeking long-term care benefits. However, as you’ll see below, when only one spouse desires Medicaid benefits to help pay for their home-health care, assisted living facility or nursing home care, eligibility is much easier.
I should note that an experienced elder care lawyer with substantial Florida Medicaid planning experience can legally and ethically help those who do not already qualify by using Medicaid’s own rules to protect assets (that is the bulk of what I do - i.e. help people protect their assets now and get Florida Medicaid to pay for some or all of their long-term care expenses).
Florida Medicaid Asset Limits for a Married Couple if Only One Needs to Apply for Florida Medicaid Benefits
Typically, when one spouse needs extra help with their activities of daily living, the other spouse acts as the primary caregiver. Usually, when the sick spouse can’t get out of bed, or needs to be lifted to get to the toilet, or cannot feed him or herself, the healthy spouse just won't be able to do it all on their own. Living at home is still desirable, but extra help will be needed to make that happen. Or, if one spouse has a sudden stroke or heart attack, it may become impractical or impossible for them to live at home.
In either of these situations, the well spouse (referred to as the “community spouse” in Medicaid parlance, will be entitled to keep up to the community spouse resource allowance (CSRA), which changes from time to time. As of July 2019, the CSRA is: $126,420.00. That means that the community spouse can retain up to the CSRA, while the medicaid spouse keeps no more than $2,000.00 (so the married couple can have $128,420.00 between the two of them) on top of other assets that are considered exempt or non-countable for Medicaid eligibility purposes.
The Medicaid applicant will not only need to pass the Asset Test. They will also need to pass the Income Test.
Income Limits for Florida ICP or Medicaid Waiver Program
The income test for long-term care Medicaid eligibility is the same regardless of whether the applicant is married (with a community spouse or if other spouse needs Medicaid as well) or single. In any of the above-permutations, the Medicaid applicant can earn no more than the income cap amount, which changes from time-to-time in Florida. As of July 2019, the Florida Income Cap is $2,313.00 per month. DCF will ask for statements from all income sources (e.g. social security, retirement account distributions, rental income, etc…) and if the total gross amount from all sources exceeds $2,313.00, then a Miller Trust (a/k/a/ Medicaid Income Trust, a/k/a Qualified Income Trust) will be required. Click the link to an article that further describes how a Medicaid Income Trust works.
Is Community Spouse Income Included in the Income Test Calculation for Nursing Home Medicaid Eligibility?
If the Medicaid applicant is seeking nursing home care, the community spouse’s (well spouse) income is not factored into the eligibility test. So if the community spouse receives a healthy income it will not need to go towards paying a skilled nursing facility.
However, oftentimes the issue isn’t that the well / community spouse is receiving a higher income. More often, they depend on the medicaid spouse’s income to pay ordinary living expenses; which in a skilled nursing facility context, means that they risk losing a precious source of income to the nursing home. This is because the medicaid program that pays for home health or ALF care doesn’t take any of the medicaid applicant’s income, however the medicaid program that pays for nursing home care, results in a near 100% loss of the medicaid applicant’s income!
In a nursing home medicaid context, there are concepts known as the minimum monthly maintenance needs allowance, and shelter allowance, that allow the diversion of some income form the medicaid spouse to the community spouse.
If that still isn’t enough, your Medicaid planning attorney will have other strategies that can help increase the amount of income that is diverted to the community spouse to help meet their needs.
How is the Community Spouse’s Income Factored in the Income Cap Test Calculation for Home Care or ALF Medicaid Eligibility?
Interestingly, the rules in this situation are unclear. My experience is that Medicaid case workers will apply ICP rules to a home and community based services application when the rules are otherwise silent. To date, I have not had a problem where a non-medicaid spouse’s income negatively impacted their spouse’s application.
An elder law attorney's function is to assist those who do not already meet the Florida Medicaid Income and Asset Test requirements. If you would like to further discuss how to protect income and assets and qualify for Medicaid now without having to go broke first and without having to wait five years, please call to schedule a consultation.