BREAKING NEWS – Some Floridian’s Medicaid Eligibility is At Risk, Starting April 1, 2023
BREAKING NEWS – Some Floridian’s Medicaid Eligibility is At Risk, Starting April 1, 2023.
In Florida the Department of Children and Families (DCF) determines eligibility for Medicaid.
As required by the Coronavirus Response Act, passed in March 2020, in response to the COVID public health emergency, DCF implemented a process to maintain Medicaid eligibility even for those individuals who did not meet DCF’s technical requirements.
A large number of Floridians on Medicaid were not asked to recertify (normally an annual process).
However, as of March 31, 2023, this "Medicaid leniency" will come to an end per the terms of Florida's Medicaid Redetermination Plan.
More Floridians on Medicaid should anticipate re-certifying and providing proof of their continued eligibility.
For those on the Medicaid Waiver / HCBS Program (which pays for some Home Health Care or Assisted Living Facility care) or the Institutional Care Program, ICP (which pays for Skilled Nursing Facility / Nursing Homecare), below are some common traps to avoid:
1. Failing to Properly Fund their Qualified Income Trust / Miller Trust Each Month.
To remain eligible for either of the above Medicaid long-term care programs, all gross income that exceeds the program’s income cap of $2,742.00/month (as of January 2023), must be deposited into a Qualified Income Trust (QIT) each and every calendar month.
We always try to remind our clients about how important it is to properly fund their Miller Trust / QIT each month. But some Medicaid recipients forget.
When DCF conducts their review / requests a re-application, you will be asked to provide bank statements showing that the correct amount of money has flowed from the Medicaid recipient's checking account (usually where they receive their social security check + pension deposits, etc...) into a separate Qualified Income Trust bank account.
Below, there is a video you can click on that further discusses "How Much Income Goes Into a Miller Trust," if you are interested in further exploring this topic.
Essentially, if you have not been properly funding your QIT account each month, please immediately correct the problem starting this month.
2. Forgetting about their $2,000.00 Asset Limit Each Month
To remain eligible for Florida’s Medicaid Waiver or ICP Program, the Medicaid recipient must spend at least one day, each calendar month, with no more than $2,000.00 in total countable assets (the exception is that for those on SSI, not to be confused with Social Security Retirement Income, then one must have $2,000.00 or less in total countable assets on the 1st day of each calendar month).
For many people, there is no problem spending their own money to keep their accounts, regularly, below $2,000.00.
However, other Medicaid recipients might have, for example, two bank accounts (e.g. a checking and savings account) and mistakenly believe that they can have $2,000.00 in each account.
Or maybe they never had lower than $1,600.00 in their checking account nor lower than $500.00 in their savings account. This fictional Floridian has, in fact, $2,100.00 in countable assets per Medicaid standards and is not eligible for Medicaid.
In short: Florida Medicaid looks at all applicable financial accounts and adds them together. If the sum exceeds $2,000.00 throughout any calendar month, this person is technically ineligible for Medicaid for that month.
3. Forget to Change Your Address with DCF
If you have moved it is important that Medicaid DCF understands this and has your new address on file.
4. Failing to Report New Source of Income or New Asset
Some individuals on Medicaid will receive a new source of income or asset, which they did not have when they were initially approved for Florida Medicaid. Most often this comes from an inheritance or personal injury settlement. There are a few potential pitfalls to be aware of here:
(a) if the inheritance or settlement funds are gifted away or disclaimed/refused, this can be considered a gift subjecting the individual to a period of ineligibility.
(b) the inheritance or injury proceeds simply sits in the Medicaid recipient's bank account causing them to spend substantial time above $2,000.00.
A Medicaid Plan should be created before receiving such funds so they can be protected while maintaining their government benefits. Or if the funds are spent down in the same month, it must be properly reported to DCF/Medicaid through a "change in circumstances."
Elder Needs Law, PLLC helps people legally and ethically qualify for Medicaid long-term care benefits who both (a) are not initially qualified for Medicaid; or (b) who are on Medicaid and have received (or are going to receive) an influx in assets (e.g. from a personal injury settlement or inheritance) that will jeopardize their needs-based public benefits.
If you need help with this or your re-application / re-certification, please schedule a consultation today.