Nursing Home Medicaid - Financial & Insurance Services

Test #1: The Medical Test - also known as The "CARES" Assessment

Eligibility for Medicaid's Institutional Care Program (ICP) depends first upon whether or not the applying person requires the appropriate "level of care." In other words, the applying person must be "medically eligible."

The Comprehensive Assessment, Review, and Evaluation for Long Term Care Services (CARES) is Florida's Long Term Care preadmission screening program for applicants for skilled nursing facility placement. The Assessment is done on-site and is typically done by a Registered Nurse and a Social Worker, and is administered by the Department of Elder Affairs.

The Assessment seeks to identify and establish the applicant's Level of Care (LOC).

If a person meets the LOC requirement, then two financial tests are applied: The Income Test and The Asset Test.

Test #2: The Income Test - based on Florida's Medicaid ICP Rules

It is very important to point out and to remember at all times when planning for a married couple that each spouse's income is looked at separately and marital assets are looked at jointly, regardless of how these assets are titled.

Florida is an "Income Cap" state. This means that if a person's gross income is over $2,829 per month, then that person is ineligible for Medicaid ICP Benefits. The Medicaid Agency only looks at the applicant's income, not the applicant's spouse's income, if married. In other words, income is looked at separately.

Note that it is the GROSS income that is considered. Therefore, the Medicaid Agency will require that Medicare Part B premiums, insurance premiums, tax deductions, and other deductions be added back in.

In the event the applying person's income exceeds the income cap amount per month, then a Qualified Income Trust must be established in order to handle the excess income above the income cap, thereby allowing the applicant to pass the income test.

Test #3: The Asset Test - based on Florida's Medicaid ICP Rules

The Medicaid applicant, whether single or married, is not allowed to have more than $2,000 of non-exempt assets in their name. If the Medicaid applicant is married, then Medicaid allows the Community Spouse (the spouse who is still living in the community and not in the Nursing Home) to retain a "Community Spouse Resource Allowance" (CSRA) of up to $154,140.

Proper Titling of the assets is crucial to a Medicaid Spend-Down Avoidance Plan. Unfortunately, all too often improper transferring of assets in the hope of properly avoiding an unnecessary spend-down occurs. However, with the proper tools, much or all of your hard-earned assets may be legally protected and preserved for you and your family's continued benefit.

For example, one important aspect of Medicaid Spend Down Avoidance Planning is: What happens to the exempt assets and/or the CSRA (Community Spouse Resource Allowance) if the Community Spouse passes away first or if the Community Spouse needs to enter a nursing home after having the Nursing Home Spouse approved for Medicaid ICP Benefits???

Surprisingly, many people believe that the spouse who is in the Nursing Home will pass away first or that the Community Spouse will never need Long Term Care. It does not always happen this way. If the Community Spouse passes away first - or ends up needing Nursing Home Care themselves - then the CSRA and Exempt Assets may be completely lost without proper planning at the proper time.

CSRA and Exempt Assets may be completely lost without proper planning at the proper time.