Do You Understand Florida Medicaid Programs?
Some questions are rhetorical. Others simply don’t deserve an answer. Some don’t have an answer at all and then there are the questions that have answers so big we don’t quite know what to do with them. One such question of epic proportions is: Do You Understand Medicaid Requirements?
The Medicaid programs are federal programs administered on the state level. The program is designed as a means of offering assistance to low-income individuals that meet eligibility criteria set by each state. Florida’s eligibility is determined by age or disability in combination with income and asset limits with financial eligibility changing annually.
Medicaid benefits offer a number of different health services through providers certified to work with Medicaid. There are also various Medicaid programs. Some Medicaid programs provide full benefits while others provide partial or limited benefits.
Medicaid Programs that Provide Full Medicaid Benefits:
Supplemental Security Income (SSI): Provides financial assistance for financially eligible people over 65 as well as blind or disabled people. Those who are receiving Social Security are automatically eligible to receive Florida Medicaid.
MEDS for Aged and Disabled (MEDS-AD): Provides benefits to 65+ and disabled individuals who do not have Medicare A or B as well as individuals who are in other Medicaid programs.
Institutional Care Program (ICP): Benefitting individuals 65+ or disabled individuals in nursing home facilities, the program pays for cost of care plus general medical coverage. Participants must meet level-of-care requirements determined by the CARES Unit of the Department of Elder Affairs. Eligibility requirements may involve an Income Trust and participants may have some financial responsibility.
Statewide Medicaid Managed Care Long-Term Care Program: As of 2011, there are two types of programs that make up Statewide Medicaid Managed Care, 1) The Long-Term Care (LTC) Managed Care Program and, 2) the Managed Medicaid Assistance (MMA) Program. Medicaid participants who qualify may enroll in SMMC LTC to receive long-term care services through an LTC managed care plan.
Hospice: Benefits terminally ill individuals with applicants applying through local hospice centers or providers. Financial eligibility is the same as the Institutional Care Program (ICP).
Developmental Services Waiver Program (DS Waiver): Financial eligibility is the same as the requirements for the Institutional Care Program (ICP). This program allows individuals (age 3+) with developmental disabilities to remain at home in their community instead of living in a facility or institution. This program has limited funding so not everyone who applies and meets general eligibility requirements will gain access to benefits.
Project AIDS Care Waiver Program (PAC Waiver): Participants receive home and community-based care. The program benefits individuals 65+ or disabled individuals who have a diagnosis of AIDS. Financial eligibility is the same at the Institutional Care Program (ICP). This program has limited funding so not everyone who applies and meets general eligibility requirements will gain access to benefits.
Cystic Fibrosis Waiver Program (CF Waiver): Participants receive home and community-based care. The program benefits 18+ who are diagnosed with cystic fibrosis and require hospitalization, but who could remain at home if they were able to receive special services and care. Financial eligibility is the same at the Institutional Care Program (ICP). This program has limited funding so not everyone who applies and meets general eligibility requirements will gain access to benefits.
Medicaid Programs that Provide Partial or Limited Benefits:
Medically Needy Program: This program benefits individuals with high medical bills who are not eligible for Medicaid due to income and assets requirements. Participants of this program must have a certain amount of medical bills monthly. This minimum is referred to as the “share of cost” and the specific amount will vary based on income and number of people in the household. After the participant meets the share of cost, the DCF may approve full Medicaid benefits for the remainder of the month.
Qualified Medicare Beneficiary (QMB): Individuals who meet the requirements for this program are eligible to have Medicaid pay for Medicare Premiums for Parts A and B, deductibles associated with Medicare, as well as any Medicare coinsurance (within designated limits). This is the only Medicaid benefit associated with QMB.
Special Low-Income Medicare Beneficiary (SLMB): Eligible participants may have Medicaid pay Medicare premiums for Part B. This is the only Medicaid benefit associated with SLMB.
Qualified Individuals (QI-1): Eligible participants may have Medicaid pay Medicare premiums for Part B. The qualification income limits are higher than those set for SLMB and Medicaid’s payment for Medicare premiums for Part B are only guaranteed through this program for the remainder of the year of the current application. This is the only Medicaid benefit associated with QI-1).
Additionally, full Medicaid recipients (as well as participants of QMB, SLMB, and QI-1 programs) are entitled to Extra Help with Medicare Prescription Drug Plan costs (also referred to as Low Income Subsidy (LIS)). LIS pays the participant’s annual deductible (or most of the annual deductible), provides them with coverage during any gap period, and pays their monthly premium (to a specified maximum amount). Individuals are still responsible for co-pays.
If you need help meeting Medicaid eligibility requirements or if you aren’t sure how to manage your assets and income to prepare for Medicaid coverage in your later years, please get in touch with the Medicaid planning attorneys at Elder Solutions Law Firm today.