The myths swirling around Medicaid in Florida are numerous and persistent. For those who believe this program is a retirement strategy, it bears repeating - it is not. While Medicaid is a public benefit, there are specific guidelines for the application, approval, and funding of the benefit.
The state of Florida and the federal government share the cost of the Medicaid program. Since 2014, the State Medicaid Managed Care program manages most of the services received by Medicaid recipients in Florida. There are currently five health plans that provide medical services and long term care benefits in Brevard County.
What is the Difference Between Medicaid and Medicare?
Medicare is an entitlement program funded by Social Security tax contributions (FICA). Most people enroll after age 65, though some with disabilities or medical conditions are eligible at a younger age. Medicaid is a needs-based program with benefits appropriate to the recipient’s financial and medical situation.
Simplifying the Difference
MedicAID – Financial AID and medical services for eligible low-income residents
MediCARE – medical CARE for eligible individuals who enroll at age 65
Currently, Florida Medicaid serves more than 5.5 million Floridians with over 2.6 million of those recipients being adults (parents, elderly, and disabled). This public benefit provides access to health care for low-income individuals. Additionally, Medicaid in Florida assists the elderly and people with disabilities with the costs of nursing home care and other medical and long-term care expenses.
The keyword there is “assists.” Medicaid does not provide a full ride in retirement. Misinformation and myths provide a false sense of security, and these three myths seem to be the most pervasive.
Top 3 Myths About Medicaid in Florida
- Medicaid is an immediate benefit.
- Anyone can help you apply.
- Medicaid pays when you run out of money.
Myth #1 – Medicaid is an immediate benefit.
Fact – It takes time and planning to apply, get approved, and get funded.
Medicaid planning should be part of a solid estate plan. Overall, costs continue to rise, and seniors need to plan ahead now more than ever to ensure that they have funds to cover their healthcare through the end of life. If it appears that an individual’s assets will be depleted, Medicaid can help with the costs of care and other medical expenses.
3 Steps to Medicaid
Screening
Eligibility
Enrollment
The process of obtaining Medicaid in Florida is a multi-step and multi-agency effort. The Agency for Health Care Administration (AHCA) administers the long-term care (LTC) program, sets coverage policy, and gets eligible individuals enrolled in an LTC plan. The Department of Children and Families (DCF) determines financial eligibility for services and the Department of Elder Affairs (DOEA) determines medical eligibility and the level of care needed.
Once an individual completes the Assessment and Eligibility steps, there still can be a waiting period before enrollment. All individuals who apply to the Statewide Managed Medicaid Program are subject to a waiting list until funds are released by the DOEA. Individuals are funded based on their priority and rank in accordance with the Statewide Medicaid Managed Care Long-term Waiver Program Prioritization and Enrollment Coverage Rule.
Plan Ahead for Public Benefits
Without planning ahead, you can spend months on the waiting list, waiting to get funded. Consult with an Elder Law Attorney that specializes in Public Benefits. They can help you create a plan to minimize the time you have to wait for the money you need to help pay for care.
Myth #2 – Anyone can help you with Medicaid planning and application.
Fact – There are restrictions in Florida regarding who can help you apply for benefits.
One common misunderstanding is that anyone can apply for public benefits on behalf of a senior in need. Unless an individual has been designated in a Power of Attorney to apply for Medicaid in Florida on behalf of the senior, they cannot apply for benefits. Therefore, if someone lacks the cognitive ability to apply for themselves or has suffered a health event that leaves them incapable, applications for public benefits can only be completed by the individual designated in a proper Power of Attorney.
Additionally, it is common for unlicensed individuals to promote services to provide Medicaid planning advice and form preparation in Florida. In fact, non-attorney Medicaid planners have become such a problem that the Florida Supreme Court issued an advisory opinion (No. SC 14-211).
The Florida Supreme Court Advisory Opinion (14-211) states that a non-attorney:
- May not recommend or prepare a Personal Service Contract
- May not recommend or prepare a Qualified Income Trust including gathering the information necessary to complete the trust
- May not sell Personal Service Contracts of Qualified Income Trust forms or kits in the area of Medicaid Planning
- May not give legal advice about spending down and restructuring assets for Medicaid
- Is not regulated and has no licensing, education, or advertising requirements
The Elder Section of the Florida Bar even went a step further to warn consumers:
“As a non-attorney does not have a license to practice law, or carry malpractice insurance, you have no recourse if your Medicaid case is denied due to the fault of the non-attorney Medicaid planner.”
Medicaid planning is a complex process that should only be completed by a licensed attorney. This is especially true if the planning involves advice about Medicaid restructuring strategies. Licensed attorneys are law school graduates, who pass a state bar exam, follow rules of ethics, and are regulated by the Florida Bar. Protect yourself when you need to plan legal strategies and apply for public benefits such as Medicaid in Florida.
Myth #3 – Medicaid pays when you run out of money.
Fact – Medicaid assists with the costs of nursing home care, medical, or other long-term care expenses.
Medicaid does not pay 100% of expenses. It is a capitated, managed care program that is delivered through the health plan of the Medicaid recipient’s choice. The benefits can pay for care in a nursing home, assisted living, or for services and support at home.
Accessing Medicaid for in-home or assisted living care can be very difficult. Once funded, however, Medicaid pays the previously contracted amount to the provider. For example, if a Medicaid recipient is living in an assisted living facility and the facility (provider) has contracted with the health plan for $1,000 a month for care costs, the health plan will pay the provider directly. The balance of the monthly fees beyond the $1,000 is the responsibility of the recipient or their family.
Paying Your Assisted Living Bill Until Medicaid is Funded
We learned in Myth #1 that Medicaid is not an immediate benefit. Therefore, an individual living in assisted living who has applied for benefits is at risk of having their residency terminated if they run out of money before their application is funded. An assisted living facility in Florida can discharge residents for lack of payment with a 45-day notice.
If you have concerns about covering the costs of senior living, exploring your financial options and considering strategies is best done well before the need. Pre-planning with a seasoned Elder Law Attorney may include accessing other public benefits, such as VA Aid & Attendance, to help offset costs while waiting for Medicaid benefits to be funded.
When Should I Start Financial Planning?
Aging is stressful enough without the additional burden of worrying about how you are going to pay for it. If you are over 18 years of age, the best time to create an aging plan is now. Start by meeting with an attorney to discuss the 5 most important documents you need. As you age, the conversations with your trusted attorney can evolve into financial planning, should public benefits ever need to be part of your future.
Whether your need for Medicaid is immediate or in the future, consulting with an Elder Law Attorney near you will give you peace of mind. Their knowledge of public benefits and ethical disbursing of legal advice are two reasons Elder Law Attorneys are a Resource We Love. Learn more about how to access funds to pay for senior care in the Legal and Financial Section of our Blog.
