Medicaid Annual Eligibility Review

With such stringent asset requirements ($2,000 if single, $3,000 joint assets if married, subject to $119,220 community spouse resource allowance) and income requirements ($2,199/month in 2016), only the most impoverished of Floridians automatically qualify for Medicaid’s nursing home benefit. Almost everyone else would benefit from consulting with an experienced elder law attorney to discuss the various Medicaid planning strategies available to them, prior to applying for Medicaid.

What happens after I have qualified for Medicaid nursing home benefits?

After seeking the guidance of an elder law lawyer to deploy the right Medicaid eligibility strategies, the elder law client, and their family, breathes a collective sigh of relief when they realize that their life savings will not be decimated by the immense costs of nursing home care. They are thankful. I am honored to have helped. But the process is not complete. Medicaid, through the Department of Children and Families (DCF) does some following up.

Medicaid Long Term Care Annual Review – Medicaid Asset Verification

Every year, after Medicaid approval, the institutionalized Medicaid recipient must continue provide proof that their assets continue to remain at or below Medicaid’s standards. Providing a simple bank statement might suffice. But if the report is not made, the Medicaid benefit could be in jeopardy.

Importantly, the assets of the community spouse (the spouse who does not require nursing home care) are not counted. The community spouse could inherit millions and the institutionalized spouse would still qualify for Medicaid.

Medicaid Annual Post-Eligibility Review – Medicaid Income Verification

If the Medicaid applicant’s income exceeded a gross amount of $2,199.00 per month when they applied for Medicaid, undoubtedly an elder law attorney helped create a d4B Trust, also known as a Miller Trust or Qualified Income Trust.  DCF will want to review bank statements of the Miller Trust to ensure that the income deposited into it is withdrawn only for permissible purposes (i.e. paying the nursing home bill, health insurance premiums or to the community spouse per their established minimum monthly maintenance needs allowance). Mishandling Miller trust funds, even by mistake, can result in jeopardizing one’s nursing home Medicaid benefits.

 Self-Reporting a Change in Financial Circumstances

Within 10 days of a major change in circumstances (e.g. Medicaid recipient obtains a personal injury settlement – perhaps the one the put them into the nursing home in the first place – or receives an inheritance, or sells their house, or is now receiving alimony from a divorce, etc…) the Medicaid recipient must notify the Florida Department of Children and Families. If this is mistakenly or purposefully hidden from DCF, and they find out, Medicaid benefits will be withdrawn and, to make things worse, Medicaid will begin seeking reimbursement for services that they paid for (from the newly found/inherited/obtained assets).

If there is a “change in circumstances,” call your elder law attorney immediately. To assist you or a family member in qualifying for Medicaid in the first place, we would be honored to be your elder law attorney. NKP assists those in crisis (suddenly in need of nursing home care) and those who have the foresight to preplan for the likelihood of requiring skilled nursing care in the future.