Income and Asset Limits for Medicaid and VA Planning in Florida
We earlier discussed the astronomical costs of long-term health care and how Medicaid and VA planning can protect assets. For most individuals and families, it’s a vital part of the life-care planning process as we and/or our loved ones age.
If you’re reading this, you, a partner/spouse or other household family member are likely among the nearly 4.5 million folks aged 65 or older in Florida (the second-highest senior population in the U.S.). Taken a step further, you’re likely one of the 20% of Americans who require coverage under Medicaid — and another 1.4% receive VA benefits as former active-duty military personnel.
So let’s recap:
- Medicare and most other insurances don’t cover a nursing home stay beyond 100 days, meaning you and/or your family will be responsible to pay out of pocket or from savings, property or financial assets.
- A semi-private nursing home room in Florida these days costs nearly $9,000 a month.
- Other services requiring coverage may include (among others), adult day care/respite care, home health care, assisted living, and homemaker services.
- If not covered, health care providers and companies WILL TARGET YOUR SAVINGS AND ASSETS to cover the cost of services.
But first, you must be eligible for Medicaid or VA attendance.
What are the Income and Asset Limits for Medicaid?
Medicaid is a federal-state partnership that allows states to administer their own programs and determine payment methods, coverage options for individuals and families, care models and more.
The Florida Medicaid system provides coverage for three tiers of eligibility:
- Institutional/Nursing Home Medicaid
- Home and Community-Based Services
- Regular Medicaid for the Aged, Blind and Disabled
Medicaid eligibility is then broken down into applicant categories:
- Single
- Married (both spouses applying)
- Married (one spouse applying)
Applicants among the different categories must meet income and asset criteria to be eligible. Here are the 2021 income and asset limits for each, according to the latest figures from the American Council on Aging.
Institutional/Nursing Home Medicaid
This is considered an entitlement, meaning everyone who meets eligibility criteria can receive assistance. Recipients must receive this level of care in an institutional environment, such as a formal nursing home or assisted-living facility.
Single
Income Limit: $2,382 per month
Asset Limit: $2,000
Married (Both Spouses Applying)
Income Limit: $4,764 per month, split equally between spouses
Asset Limit: $3,000
Married (One Spouse Applying)
Income Limit: $2,382 per month, for the applicant
Asset Limit: $2,000 for the applicant; $130,380 for the non-applicant spouse
Home and Community-Based Services
These include long-term care services that may be offered at home or through other community organizations including (among others) assisted-living residences, adult day care (or respite care), and adult foster homes. In Florida, services are compensated under a managed-care system so benefits are paid out through one agency. The goal — for government agencies and individuals alike — is for more care recipients to live independently at home as long as possible.
Single
Income Limit: $2,382 per month
Asset Limit: $2,000
Married (Both Spouses Applying)
Income Limit: $4,764 per month, split equally between spouses
Asset Limit: $3,000
Married (One Spouse Applying)
Income Limit: $2,382 per month, for the applicant
Asset Limit: $2,000 for the applicant; $130,380 for the non-applicant spouse
Regular Medicaid for the Aged, Blind and Disabled
This also is an entitlement accessible to all who are eligible. Services may be rendered at home or in adult day care (respite care) situations.
Single
Income Limit: $948 per month
Asset Limit: $5,000
Married (Both Spouses Applying)
Income Limit: $1,281 per month, total
Asset Limit: $6,000
Married (One Spouse Applying)
Income Limit: $2,382 per month, total
Asset Limit: $6,000
What are Considered Assets and Income?
Another fantastic question, and make no mistake, it’s crucial to understand this because any and all of it will be counted. The goal of Medicaid is to provide quality health care to low-income individuals and families, to limit or eliminate out-of-pocket costs. It covers approximately 20% of all Americans. The government wants to ensure it benefits only those without significant financial means that could otherwise pay for health care and services.
But eligibility is strictly monitored in terms of income and assets. Income may include salary/wages from full- or part-time employment, stock dividends, Social Security and/or Disability income, pensions and other forms of compensation. Assets may include cash, stocks and bonds and other investments, savings and checking accounts, and non-residential real estate. Of course, there are exceptions, such as personal belongings, vehicles, furniture/decorations, and burial funds.
Special circumstances may allow individuals and couples to still qualify if they’re over income and asset thresholds. These include the Medically Needy Pathway, Qualified Income Trusts, and Medicaid Planning (what I do!). We’ll also discuss these soon!
Medical and long-term care under Veterans Affairs (VA) is also a means-tested program (for which we work with attorneys and VA accredited claims agents to provide professional consultations and assistance).
Most Medicaid spending at the state and national levels covers aging individuals and those with terminal illnesses like Alzheimer’s disease and other types of dementia, as well as cancer and organ failures. It helps those in assisted living, nursing care, or hospice or palliative care. But a great deal of care also goes to mothers, children and dependent young adults from low-income households, especially after expansion under the Affordable Care Act (ACA).
Are You Ready for a Conversation About Medicaid and VA Eligibility in Florida?
Given that we’ve discussed eligibility so much, you may wish to begin for yourself with a Medicaid-eligibility test. Those seeking Medicaid or VA eligibility often must spend down or legally distribute considerable assets among family, friends and other appropriate parties before a “5-year lookback” time frame.
Medicaid planning legally protects an individual’s assets to care for you and yours, in addition to Medicaid and VA benefits. Caregiver Support & Resources, LLC works with elder-law attorneys, and we can legally and ethically protect people’s assets to help them qualify for Medicaid and VA. Medicaid, unlike Medicare, will cover most long-term care costs. Once we obtain Medicaid eligibility for an individual, if they remain within the Medicaid guidelines, they will have eligibility for the rest of their lives. Likewise for VA Aid and attendance.
There’s no reason an elder or their spouse should live in poverty for transitioning to higher levels of care. Our clients, their families and future generations may still live in comfort and dignity.
