The state of Florida is changing the rules that dictate when Medicaid benefits must be applied for while eliminating retroactive coverage that was once available for sick or disabled individuals facing healthcare challenges with limited means.
Starting February 1, 2018, Florida will no longer allow patients to receive three months of retroactive coverage for Medicaid. Instead, seniors or patients who may be eligible for Medicaid for nursing home care or other healthcare costs will now be required to file their application within the month that they need care.
What Is Retroactive Medicaid Coverage and Why Is It Important?
Medicaid is a federal program that is administered by each individual state in order to help people who have limited income cover their medical costs. Under the federal rules for Medicaid, a person can receive retroactive coverage for up to three months prior to the date that they applied for benefits if the applicant met Medicaid’s standards during that month.
The reason for this rule is simple: healthcare issues can be unexpected. A stroke could happen without warning. A person with limited means could get into a car accident. A senior may fall and need nursing home care. The government understands that in the midst of a healthcare crisis, it can be difficult to file a Medicaid application in order to access benefits to pay for care.
For starters, the patient may not be in any mental or physical condition to handle their financial and medical affairs. Or, the senior or patient may not realize that they are eligible for Medicaid benefits until much later in their recovery when they have the ability to talk with social workers or an attorney. Plus, applying for Medicaid can be challenging—often requiring the senior or individual to produce five years’ worth of bank statements, comprehensive lists of assets, and other financial proof in order to qualify. This information is difficult for a healthy person to pull together, let alone someone who is in the hospital or dealing with a medical crisis.
So, the government gives patients and seniors some breathing room to get their application in. Whenever the senior or patient is finally able to apply for benefits, the government will go back up to three months to retroactively pick up the costs.
However, Florida Has Received A Waiver to Eliminate This Federal Provision
Remember, Medicaid is a joint federal and state program. Each state has the ability to apply for a waiver to the federal Medicaid rules if the objective is to “enhance fiscal responsibility.” Florida has eliminated retroactive coverage on these grounds.
Under the new rules now set forth by Florida, a senior or patient will only receive retroactive payments back to the first day of the month in which they applied. So, if a senior is placed in a nursing home on January 1st but doesn’t apply for benefits until March 15th, the senior will only receive coverage for any costs incurred starting March 1st. That means all costs from January 1st – March 1st would be the patient’s responsibility.
Because of this new provision, patients and seniors will need to apply for benefits as soon as possible if they believe they are entitled to them to cover the cost of their healthcare or long-term care. Otherwise, the senior or patient could be stuck with thousands, if not hundreds of thousands, of dollars in medical costs that Medicaid will not retroactively cover.
Not Sure If You Qualify for Medicaid Benefits? Talk to Our Estate Planning Attorneys.
As I mentioned, Medicaid is a complicated program, and applying for benefits can be a difficult and time-consuming process. Because time is now of the essence to file for benefits, any adult or senior who is in need of Medicaid benefits to help pay for care should talk to an attorney about the best ways to move forward with their claim. Even if you think that you won’t qualify, our experienced Medicaid attorneys may be able to help you utilize planning strategies to access the benefits you need. We are also familiar with all of the rules and regulations of the program to help you receive benefits in the fastest way possible.
If you are concerned about these rule changes and you’d like to talk about your ability to access Medicaid, or if you or a loved one is currently receiving care and you have not yet filed an application for benefits, please contact our office at (813) 438-8503. We’d be happy to meet with you to discuss your needs and help you map out a plan to access the benefits you may be entitled to.