Medicaid provides Medical coverage to low income individuals and families. The state and federal government share the costs of the Medicaid program. Medicaid services in Florida are administered by the Agency for Health Care Administration.

Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).

DCF determines Medicaid eligibility for:

  • Low income families with children
  • Children only
  • Pregnant women
  • Non-citizens with medical emergencies
  • Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI)

Key Medicaid Numbers for 2012

The income and asset limits for those needing nursing home Medicaid have increased in 2012.  The income limit for a Medicaid applicant has increased from $2022 per month to $2094.  Income over $2,094 must be placed into a Qualified Income Trust (sometimes called a “Miller Trust”) in order for the applicant to qualify for Medicaid.

Although the applicant’s assets still cannot exceed $2,000, the community spouse’s allowable assets have increased from $109,560 to $113,640 as of January 1, 2012.  If a community spouse’s assets (excluding exempt assets) exceeds $113,640, he or she should meet with a qualified elder law attorney to explore planning to help the applicant qualify for Medicaid.

The maximum home equity limit for 2012 is $525,000 with a maximum of $786,000 (although Florida has not adopted the maximum amount).

Medicaid for Aged or Disabled

Medicaid for low income individuals who are either aged (65 or older) or disabled is called SSI-Related Medicaid.

Florida residents who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid coverage from the Social Security Administration. There is no need to file a separate ACCESS Florida application unless nursing home services are needed.

Individuals may apply for full Medicaid coverage and other services using the online ACCESS Florida Application and submitting it electronically. If long term care services in a nursing home or community setting are needed, the individual must check the box for HCBS/Waivers or Nursing Home on the Benefit Information screen. HCBS/Waiver programs provide in-home or assisted living services that help prevent institutionalization.

Medicare Savings Programs (Medicare Buy-In) help Medicare beneficiaries with limited finances pay their Medicare premiums; and in some instances, deductibles and co-payments. Medicare Buy-In provides different levels of assistance depending on the amount of an individual or couple’s income. Individuals may apply for Medicare Buy-In coverage only by completing a Medicaid/Medicare Buy-In Application.

Print the form, complete it and mail or fax it to a local Customer Service Center.

Individuals eligible for Medicaid or a Medicare Savings Program are automatically enrolled in Social Security’s Extra Help with Part D (Low Income Subsidy) benefit for the remainder of the year. An individual may also apply directly with Social Security for the Medicare Extra Help Program. Individuals who do apply directly for the Medicare Extra Help Program have the option of having the same application consideration for the Medicare Savings Program. If the individual takes the option of having the Medicare Extra Help Program application considered for the Medicare Savings Program, the Social Security Administration will send information electronically to Florida and the individual will be contacted.

If you are in need of medicaid assistance for an elderly loved one, contact the Law Offices of Laurie Ohall today to get started.