Will Florida Medicaid Cover Nursing Home Costs?
The state of Florida provides a number of services through long-term care managed care plans for those who qualify. These services may include assisted living facility and nursing facility care, some in home services, and medical equipment. There are two parts to the qualification process required for Florida Medicaid Long-Term Care Managed Care plans. An individual must first need nursing home level care and second, they must meet financial eligibility requirements.
Qualifying for Florida Medicaid: Medically Necessary Nursing Home Level Care
To qualify for Florida’s long-term managed care plan, you have to require nursing home level care. You must be able to show that your medical condition or overall health is such that you either need to live in a nursing home with 24/7 nursing care available, or that you would need to do so if you were not already receiving long-term care services.
Florida’s screening program for long-term care applicant is called Comprehensive Assessment and Review for Long-Term Care Services (CARES) and the assessments are conducted by the Department of Elder Affairs. Applicants are interviewed with questions about their health, ability to function, how much help is necessary, and any conditions you may have. Once the assessment is completed and you are able to show that you meet the nursing home level of care requirement, you must show that you meet the income and resource limit Medicaid requirements.
Once enrolled in the program, Florida Medicaid recipients must show that the service you want is medically necessary. If a service is not medically necessary, Medicaid will not cover the costs. For the purposes of Florida Medicaid, medically necessary means that it is necessary to protect life, prevent significant illness or disability, or alleviate severe pain, is consistent with symptoms of the condition under treatment, is consistent with generally accepted professional medical standards, is safe to administer with no equally effective and more conservative service or less expensive treatment available in the state, and it is furnished in a way not specifically intended for the convenience of the patient, the patient’s caregiver, etc.
If you need help determining if you will qualify for Florida Medicaid or if you would like to discuss Medicaid Planning, please get in touch with one of the experienced Medicaid Planning attorneys at Elder Solutions Law Firm today.