Understanding The Maze of Florida's Long Term Care Medicaid Programs

Author

Isenhour Senior Services

Posted on

May 22, 2024

Book/Edition

Florida - Southwest

Share This

As a Certified Senior Advisor specializing in Medicaid representation in Florida, our staff goes breathless attempting to explain the differences between the various long term care Medicaid programs offered here in Florida.  In this article, I will attempt to cover as many aspects of these programs as possible and assist you through this maze of confusion.

 

Long Term Care Programs:

 

1.   ICP - Institutional Care Program (Nursing Home Medicaid) – This  program is the one that most of the inquiries to our office are calling about.  ICP is for nursing home residents who need assistance in paying the high cost associated with this level of care.  The private pay cost of this type of care can range anywhere from $9,000 to over $15,000 per month.  This program is for those who possess a need of assistance with at least 3 activities of daily living (bathing, dressing, toileting, transferring, feeding oneself) or are a hospice patient in addition to residing in a skilled nursing facility.

2.  Hospice - For individuals with a life expectancy of 6 months or less.            While Hospice services are primarily covered by Medicare, if a person resides in a nursing facility and are applying for Medicaid, hospice would assist in managing the care even in the nursing facility.

3.  HCBS - Home and Community Based Services (Waiver programs)

A.  Hope Pace - All-inclusive medical program that assists people who are living independently.  The individual is expected to use the medical professionals that Hope Pace contracts with and recipient would attend their health center at least one day per week to see doctors there.  Transportation is provided in addition to many other benefits. This program provides supportive services in order to allow the applicant to maintain their independence and the goal is to avoid placement for as long as possible.  Hope Pace is a pilot program and not available in all counties.  For more information, their phone number is 239-985-6400.

B.  Medicaid Waiver for care at home, daycare or in an Assisted Living Facility-These programs are funded and have a waiting list which is managed by a State agency called the Area Agency on Aging.  Each person who calls to be added to the waiting list is given a phone assessment appointment to be called by the agency at a later date and asked a series of questions. The phone assessment takes about 45 minutes and afterward the recipient is given a priority score based on physical need for care and is placed on the list based on their priority score. Those with the most need for assistance with activities of daily living are given a higher priority score than others with less need for physical help. The goal is to avoid nursing home placement, so those at a higher risk of possible nursing home placement are moved to a  higher position than those that are more independent.  They will usually ask financial questions as well during the phone assessment. Phone number for Area Agency on Aging is 239-652-6900.  

 

Qualification and Procedure:

 

         All long-term care Medicaid programs have the same income and asset limitations.  The applications are submitted using an online portal through the Department of Children and Families (DCF). You may also fax in a paper application to the department, but submitting online gives access to information much more efficiently than waiting for notifications to come via U.S. Mail. Since you would be using the online portal, you may log in whenever you would like to check on your case and the online portal allows changes to be reported more easily and notices may be viewed upon generation.  This application process is comprehensive in terms of all financial aspects of the applicant’s situation in order for the caseworker to determine eligibility.

The Medicaid applicant income limit is currently $2,829 per month and increases each year commensurate with Social Security cost of living adjustments.  The individual’s gross income is what is counted which is the amount prior to any deductions such as Medicare or other health insurance premiums, tax withholding, union dues, life insurance premiums, etc.  If the applicant’s gross countable income exceeds the limitation, they would need to obtain the assistance of an elder law attorney to provide a remedy.  Isenhour Senior Services is not a law firm, but would be able to offer a list of competent attorneys to contact for the purpose of legal needs as they arise.

 Allowable assets may include Florida homestead with a maximum value of $713,000 for a single individual and unlimited value if a spouse or minor child is living in the home; other income producing real estate that is producing fair market value income (net income after calculated expenses is counted as income); additional property that is listed for sale at fair market value; vehicle of any value; IRAs if there is an income distribution in place; Irrevocable funeral arrangements of any value; An additional $2,500 in other burial funds which can be in the form of savings, life insurance cash value, or other assets that the value can be verified; and up to $2,000 in other liquid or non-liquid assets.

         For nursing home Medicaid applicants, if there is a spouse living in the community, the community spouse’s resource limit is $154,140 in addition to the previously mentioned items.  For nursing home applicants, there is usually a dollar amount that is to be paid from their income called a patient responsibility.  The patient responsibility is paid to the nursing home and Medicaid pays the remaining balance of the charges.  The applicant is allowed to keep $160 for personal needs and enough to cover any medical premiums such as dental or health insurance, hearing aid leases, etc.. 

         When there is a community spouse living at home or in a private pay assisted living facility and their ill spouse is applying for nursing home Medicaid, their information is also included in the applicant’s application for benefits and the community spouse may possess the ability to retain some of the applicant's income in order to meet their shelter expenses in the community.  Currently the State of Florida allows the community spouse to retain a minimum of $2,465 from both spouse's income sources in order to meet their needs in the community.  If the spouse has excess shelter costs, such as assisted living expenses, mortgage, rent or other high shelter expenses, they are allowed to keep more of the applicant's income, with a maximum total income allowance of $3,854 per month.  This amount includes both spouse’s gross monthly income.  If the community spouse needs even more than this amount to cover their expenses in the community, they may wish to seek legal advice for a court order for spousal support.

         For the Assisted Living Medicaid Waiver program, once the applicant’s name has come up on the Area Agency on Aging’s waiting list and the application is submitted and approved (usually a 60-day time period), then benefits begin the following month. The Medicaid recipient would then need to choose a managed care provider which would be the one that the facility they are preferring accepts.  That provider would contribute up to somewhere between $1300 and $1600 per month toward the charges after the recipient has contributed their income minus allowances.  The rest of the ALF’s charges would still need to be paid so that the facility still receives full payment.  If the recipient’s income is not sufficient to cover the remaining charges and the family cannot cover the shortfall, the recipient may need to enter a nursing home if they qualify physically for that level of care, since nursing home Medicaid only expects the applicant to pay in less than their monthly income as their patient responsibility.  This same Medicaid Waiver program can assist with homecare hours and other services which would help them to remain in their home if that is a safe decision.

         For all long-term care programs other than Hospice, there is a physical level of care evaluation that is completed by the Department of Elder Affairs which would determine if the individual meets the physical need of the program for which they are applying.  This evaluation is requested by sending a 3008 form that has been completed and signed by the individual’s physician along with additional medical records including medication list to the Department of Elder Affairs.  An assessor would then make arrangements for an evaluation to be performed wherever the individual is residing.  The final report is then provided to the Department of Children and Families, and added to the financial documentation already sent in by the applicant and then the DCF caseworker is able to open the benefits for which the applicant had applied if all qualifications have been met.

         If the individual had applied for nursing home Medicaid, the effective date of the Medicaid approval would be the 1st of the month that the application was submitted, providing the individual was eligible beginning in that month.  The waiver programs are forward-moving programs in that benefit begins the 1st of the following month after approval is granted and  enrollment in a Medicaid managed care plan.  The plan that is chosen would provide a case manager who would contact the recipient and/or family to discuss the applicant’s needs and plan of care.  The case manager would also remain involved in the client’s ongoing care needs.

         In order to continue ongoing benefits, the applicant must submit a renewal of benefits each year with the Department of Children and Families and is also responsible for reporting any changes that occur along the way,  such as changes in living arrangements, income, expenses, assets, etc.  The physical level of care evaluation does not need to be repeated each year, only the financial piece.

         So, as you can see, the web of confusion that is created by Florida’s Medicaid long term care system is forever in need of explanation.  What I have provided here is a plethora of information to comprehend and we are here for you to help you through this maze.

 

Christine Isenhour

President

Isenhour Senior Services

239-542-7366

Other Articles You May Like

The Impact of FTRI Specialized Phones: Enhancing Communication for Floridians

Since 1991, Florida Telecommunications Relay, Inc. (FTRI) has improved the lives of Floridians experiencing hearing loss and speech impairments, through its specialized telecommunications Equipment Distribution Program (EDP). Established by Floridas Telecommunications Access Systems Act (TASA) in response to the passage of the Americans with Disabilities Act of 1990, FTRIs EDP oers an array of devices designed to bridge communication gaps.  Per TASA, a monthly 7-cent surcharge on landline phone bills covers the cost of FTRI distributed equipment, and the Florida Relay Service.  By providing equipment at no cost to consumers, FTRI is empowering individuals to lead more independent lives while remaining connected to the world. Let's take a look at several FTRI specialized devices and explore some heartwarming client stories that illustrate their profound impact on everyday lives.   Understanding FTRI Specialized Phones   FTRI specialized equipment caters to a range of communication needs. The devices include amplified phones, cell phone amplifiers, captioned telephones, text telephones (TTYs), and alerting devices. Each type is engineered to address specific needs:   1.     Amplified Phones: These phones are equipped with volume controls that can amplify sound significantly, up to 50 decibels, making it easier for individuals with hearing loss to understand conversations. They also feature tone settings, loud speakerphones, back-lit buttons, and loud ringers.2.     Cell Phone Amplifiers: Amplifiers use Bluetooth technology to wirelessly   pair with smart phones (Android, iPhone).  These portable, rechargeable devices allow a user to enjoy many of the same features found on standard amplified phones, such as volume and tone controls, hearing aid compatibility, and loud speakerphones.   3.     Captioned Telephones:  These devices display real-time captions of the conversation on a large screen, helping those with severe hearing loss to  read what the other party is saying.  Screens can be customized to a users preference, and call transcripts can be saved for future review.   4.     Text Telephones (TTYs): TTYs allow individuals with hearing or speech impairments to communicate via typed messages.   5.     Alerting Devices: These include flashing lights and loud ringers to alert individuals to incoming calls.   Transformative Client Stories   Jack and His Amplified Phone   Jack, a 75-year-old retired teacher, began experiencing hearing loss a few years ago. As his hearing deteriorated, he found it increasingly difficult to keep up with phone conversations, particularly with his grandchildren who live out of state. The frustration of missing out on these precious interactions led him to seek help from FTRI.   Upon receiving the Clarity XLC8, John noticed an immediate improvement. The adjustable volume and tone controls allowed him to customize each call. For the first time in years, he could clearly hear his grandchildren's voices. The device not only restored his ability to communicate, but also brought immense joy back into his life, through an improved connection with his loved ones.   Dave and his Cell Phone Amplifier   Like so many other Floridians, Dave disconnected his landline years ago.  He relied on his iPhone to make all his phone calls. Over time, however, he found himself using texting to avoid making calls whenever possible, because the iPhones volume was simply not loud enough for him to hear conversations clearly.   Daves daughter reached out to FTRI with questions about the Clarity XLCgo Cell Phone Amplifier, hoping it might be easy enough for her father to operate.  Both father and daughter were delighted to learn that the XLCgo connects to smart phones by Bluetooth quite easily, and is designed to be used both at home and on the go.  Once Dave had paired his iPhone to the XLCgo and realized he could once again enjoy conversations over the phone, there was no looking back for him.   Maria and Her Captioned Telephone   Maria, a 62-year-old librarian, was diagnosed with profound hearing loss, which made phone conversations nearly impossible.  This posed a significant challenge in her life, where communicating over the phone was essential for both personal and professional reasons.  Feeling isolated and frustrated, Maria turned to FTRI for a solution.   FTRI provided Maria with a captioned telephone.  This device transformed her ability to communicate. The real-time captions allowed her to read conversations, ensuring she could understand every word spoken.  Saving call transcripts for future reference became routine for her, especially for calls with her doctor to discuss medications. The captioned phone improved her life by restoring her sense of independence, safety, and competence.   Sam and His TTY Device   Sam, a 45-year-old software developer, was born with a severe speech impairment. Communicating over the phone was always a daunting task for him, often requiring the assistance of a family member or colleague. This dependency made Sam feel self-conscious and restricted his ability to handle personal and professional matters independently.   FTRI introduced Sam to a TTY device and the Florida Relay Service, which revolutionized his communication experience.  The TTY allowed Sam to type his messages, which were then converted into voice for the person on the other end of the line by the Relay Service.  Likewise, he received typed responses that he could read. This device gave Sam the autonomy he craved, enabling him to manage personal communications without assistance. The TTY device empowered   Sam, boosting his confidence and fostering a greater sense of independence. The Broader Impact of FTRIThe stories of Jack, Dave, Maria, and Sam are just a few examples of how FTRI specialized phones are transforming lives across Florida. By providing these devices at no cost, FTRI is removing financial barriers that might otherwise prevent individuals from accessing essential communication tools. This initiative is fostering inclusivity, ensuring that everyone, regardless of their impairments, can stay connected with the world around them. Moreover, FTRI's eorts extend beyond just providing devices. The organization also oers training and support to help users get the most out of their specialized phones. This comprehensive approach ensures that individuals are not only equipped with the necessary tools but are also confident in using them eectively. To learn more about FTRIs Equipment Distribution Program, visit www.ftri.org, or call 800-222-3448.

The First 100 Days: A Survival Guide for New Professional Caregivers

Professional caregivers in Cape Coral serve a vital role in providing care and support to aging, ill, and disabled individuals. As someone new to the profession, you are embarking on an exciting career journey to make a meaningful impact on the lives of others. However, the first 100 days for new professional caregivers can be demanding, making it essential for them to find ways to manage workplace challenges as they present. What follows are survival tips and strategies every new professional caregiver should include in their 100-day strategy.New Professional Caregivers Face These ChallengesWhile even the most experienced caregivers face challenges that include physical ailments, compassion fatigue, and maintaining a work-life balance, those new to the profession are more likely to struggle with these issues:Emotional StressOne of the most significant challenges for new caregivers is coping with the emotional stress that comes with the job. Providing care for individuals who are sick, elderly, or disabled can be emotionally taxing, especially when faced with their pain, suffering, or deteriorating health.Lack of ExperienceMany new caregivers enter the profession with limited or no prior experience. This lack of experience can make it challenging to handle the various tasks and responsibilities that the job requires, from administering medications to providing personal care.Time ManagementProfessional caregivers must often juggle multiple tasks and responsibilities within a limited timeframe. Managing time effectively isnt always easy for new caregivers, especially when they are still learning the ropes.MiscommunicationWhile effective communication is essential in any profession, new caregivers often struggle to communicate effectively with patients, their families, and other healthcare professionals. Miscommunication can lead to misunderstandings, mistakes, and conflicts that can impact the quality of care provided.BurnoutCaregiving is a demanding profession that requires physical, emotional, and mental stamina. New caregivers may be at risk of burnout if they do not prioritize self-care and find healthy ways to cope with the stresses of the job.Survival Tips for New Professional Caregivers in Cape CoralFortunately, navigating caregiving challenges during the first three to four months on the job is possible by taking the right steps. As a new caregiver, heres what to include in your 100-day strategy:Find a MentorOne of the best ways to overcome the challenges of being a new caregiver is to seek mentorship from experienced colleagues. Once under their watchful eye, a mentor can provide guidance, support, and valuable insights to help you grow and develop in your role.Prioritize Self-CareTaking care of yourself is essential for providing quality care to others. Prioritize self-care by getting plenty of sleep, eating healthy, exercising regularly, and participating in activities that help you relax and recharge.Stick to a RoutineFollowing a daily routine can help you stay organized and manage your time effectively. Creating a schedule for tasks like medication administration, personal care, and meal preparation will help ensure you can meet your clients needs efficiently.Polish Your Communication SkillsEffective communication is a prerequisite for providing quality care. Take time to actively listen, ask relevant questions, and clarify information to ensure you understand the needs and preferences of your clients and their families.Learn All You CanContinuing education is essential in the caregiving profession. Stay updated on the latest practices, guidelines, and technologies through training programs, workshops, and online resources.Cultivate RelationshipsMaintaining positive relationships with your clients, their families, and coworkers can go a long way in enhancing the quality of care you provide. Show empathy, respect, and compassion in your interactions, and be open to feedback and collaboration.Practice Self-ReflectionTake time to reflect on your recent experiences, challenges, and successes as a caregiver. Self-reflection can help you identify areas for improvement, set growth and development goals, and celebrate your achievements along the way.In conclusion, the first 100 days as a new professional caregiver can be both demanding and rewarding, with growth and learning opportunities galore. Proactively identifying potential challenges and implementing the tips and strategies above will help you navigate your new role with confidence, compassion, and professionalism. As a new caregiver, embracing the journey ahead with an open mind and a willingness to learn will help ensure you make a meaningful impact in the lives of others as your exciting career plays out.Home Care: A Dynamic Career Option for New Professional CaregiversNew caregivers employed in institutional settings often work long hours with minimal guidance while performing the same tasks day after day. As a fresh career alternative, these are some of the advantages of working in the rapidly growing home care field:Scheduling FlexibilityJob flexibility is one of the primary advantages of working in home care. Unlike traditional caregiving settings, in-home caregivers have more control over their schedules. This scheduling flexibility can help minimize stress by allowing caregivers to balance their personal and professional lives more effectively. While choosing between part-time, full-time, or flex hours, caregivers can work shifts that best suit their needs, promoting a better work-life balance.Meaningful RelationshipsAnother significant benefit is the one-on-one nature of home care. While assisting clients in the comfortable surroundings of home, caregivers can build a strong rapport and develop a deep connection with clients and their families. This long-term care approach helps alleviate stress by fostering a heightened sense of purpose and fulfillment as caregivers witness firsthand the positive impact they have on their clients lives.Personalized CareAdditionally, being an in-home caregiver typically involves a more specialized and focused approach to caregiving. Unlike other settings where caregivers tend to have a wide range of responsibilities, home care allows caregivers to focus on specific tasks tailored to each clients unique needs. This care specialization can help minimize stress by allowing caregivers to develop expertise in specific areas and feel more confident in their abilities.Professional Growth and DevelopmentThere are many opportunities for in-home caregivers to enhance their skills and knowledge. Home care providers offer training programs, workshops, and certifications that help caregivers stay updated on best practices and improve their caregiving techniques. Caregivers can also choose to specialize in different areas, including dementia care, hospice care, and geriatrics.Job SecurityFinding a job when youre a new caregiver can be stressful. According to the U.S. Bureau of Labor Statistics, the demand for home care workers will remain high for at least the next 7 to 8 years, making it a virtually recession-proof occupation.While it still has challenges, many caregivers are now choosing to work in the dynamic home care field while supporting the needs of clients and their family caregivers for these reasons. Is home care your career calling?Professional Caregivers Wanted to Join Our Winning Home Care TeamAt Home Instead in Cape Coral, we understand the challenges new professional caregivers face and are committed to providing them with the tools and resources they need to succeed. Due to our expanding client load, we are currently seeking qualified candidates to fill several exciting caregiving positions. While proudly serving the Cape Coral, Alva, Boca Grande, Bokeelia, Burnt Store Marina, Matlacha, and North Captiva Island communities, we support clients and families with compassionate home care services, including Alzheimers and Dementia Care, Arthritis Care, Companionship Care, Diabetes Care, Elder Care, Home Helper Services, Hospice Care, Meals and Nutrition, Personal Care, Respite Care, 24-Hour Home Care, and Transportation.As a highly valued member of the Home Instead Cape Coral team, youll enjoy a fast-paced, positive work environment where open communication is valued and hard work is rewarded. We also offer competitive pay, flexible scheduling, ongoing caregiver skills training, and career advancement opportunities galore. No matter your experience level or education, wed love to hear from you! To learn more about our exciting job opportunities for professional caregivers, visit us now at www.homeinsteadswfl.com/cape-coral.

Whether Its the Heat or Humidity, Its HOT

The National Weather Service outlook for this summer predicts Florida temperatures will be warmer than normal, particularly in the hottest months of July and August.The combination of high temperatures and persistent humidity adds up. Humidity makes it harder for the cooling evaporation of sweat to be effective, so it feels hotter. The Heat Index measures how hot air temperatures really feels because of humidity.  Experts recommend using caution when temperatures rise above 90 (or 84 degrees F with 70 percent or higher humidity). Temperatures above 100 F can be dangerous for anyone. As we age, sweat glands, our bodys mechanism to cool itself, dont produce as much as they once did, and are often diminished by medication. In addition, seniors are more likely to have chronic conditions such as diabetes or lung disease, which reduce our ability to cope with heat. When temperatures are high, seniors are especially vulnerable to developing heat stroke because of the aging bodys decreased capacity to adapt to changes in body temperature.With that in mind, here are some tips for sun safety when its hot:       Drink more water than you think you need. Without enough water, we can feel faint and nauseous, which can cause us to get dizzy and fall. Medications can impact how our kidneys hold water. The cues our brains send that tell us to drink can diminish as we age. Caffeine and alcohol affect our response to heat.      Skip outdoor activities between 10 a.m. and 4 p.m., when the sun is hottest. Find a cool place, such as an interior location with air conditioners and fans, staying out of the sun during the heat of the day. Take a cool shower or bath or apply a cold compress. Many places offer cooling centers with air conditioning, including public libraries, churches, recreation centers and senior centers. Go shopping or to the movies.      Watch for symptoms like dizziness, nausea, headache, being overly tired, rapid pulse or muscle cramps. Behavioral changes, like being confused, combative or delirious are serious and should be checked. Some signs of heat exhaustion or heat-related conditions, which are generally related to an excessive loss of water and salt, include skin thats very warm to the touch, extreme thirst and excessive sweating.  High heat can cause dehydration, heat exhaustion, heat cramps and heat stroke, which is a medical emergency. For any kind of heat distress, move to a cool place and put cool, wet cloths on the body or take a cool bath.   Signs of heat stroke include high body temperature, hot red or damp skin, fast pulse, headache, dizziness, nausea, confusion and passing out. If you suspect heat stroke, call 911, take the steps above and dont give the person anything to drink.   Sun exposure can impact our skin even more than when we were younger. Aging skin is thin and dry. However, less than half of older adults protect their skin from the sun, which may raise the risk of getting skin cancer.  The American Cancer Society recommends having a skin exam every three years between the ages of 20 and 40, then annually thereafter. While Medicare will not generally cover preventative screening, it will cover a dermatology visit that is medically necessary to assess a problematic skin spot or mole. Free skin screenings are offered for seniors in many places, including at https://www.moffitt.org/diagnostic-services/cancer-screenings/mole-patrol/. Summer is a great time to enjoy the company of others. Games, outings, classes, dances and other activities can keep you busy and social. Mall walking, swimming and water aerobics and gyms can be cool ways to exercise when its hot.  About the Author Reinier Ramirez, MD is a family care provider and the Medical Director of Adult Medicine at Healthcare Network, a nonprofit with a mission to provide quality healthcare accessible to everyone, regardless of job, income, or insurance. Visit HealthcareSWFL.org for more information.

Local Services By This Author

Isenhour Senior Services

Medicaid Planning 6835 Porto Fino Cir., Ste. 1, Fort Myers, Florida, 33912

Our office helps nursing home patients and assisted living residents as well as people in their own homes apply for Medicaid benefits. We stand by our work by offering a money-back guarantee our fee returned to you if you are not approved for Medicaid due to an error on our part.Our office focuses specifically on Medicaid representation with over 20 years of experience in this field. Our knowledge and ability and 100% approval rating on nearly 90 cases a year speaks for itself as well as a close working relationship with Florida government social service specialists. *Our office prides itself on its integrity, approachability, and one on one personal service with references available at the highest level upon request.* We also continue in the role of Authorized Representative for the Medicaid recipient's lifetime, performing yearly reviews in order to continue benefits, as well as processing notification of changes along the way. The Medicaid recipient or their family will never have to deal with the Department of Children and Families.Our office specializes in helping nursing home patients and assisted living residents as well as people in their own homes apply for and get approved for Medicaid benefits.Discovery Organize Application Submission Upload & Approval Commitment to you as long as neededYearly Review