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Federal Court Decision Could Sink Florida’s Medicaid Plans


Healthcare is expensive, regardless of the stage in life in which a person finds him/herself needing medical care. For those that need around the clock care in a nursing home, Medicaid is the source most turn to in order to pay the extremely high cost. Health being unpredictable, knowing when admittance to a nursing home is necessary is rarely known, and in fact, is often a sudden decision following a serious injury or the onset of a major illness or disease. As mentioned in an earlier blog entry, the Florida Medicaid program is trying to eliminate retroactive eligibility for Medicaid recipients, which allows individuals seeking benefits a 90-day window to enroll after they see a provider. Under the change, this period would shrink to 30 days. The longer coverage is crucial for nursing home residents who need time to find a facility and complete the application process, rarely attainable within one month. Kentucky is also seeking a change to its Medicaid program that imposes work requirements and increased cost sharing. However, a federal judge recently blocked these proposed changes as against promoting the objectives of the Medicaid Act. Florida’s revision to its Medicaid program could see a similar fate. A discussion of what states must show in order to change Medicaid benefits, and when Medicaid will pay for nursing home care, will follow below.

When States Can Modify Medicaid

While Medicaid is a federally-created program, the administration of the plans is primarily performed by the states. Thus, to help them better serve populations in need of care, states are permitted to try various approaches to achieving that end. However, in order to modify the function or structure of Medicaid, states must demonstrate a plan furthers a stated goal of the program. The primary objective of the Medicaid program is to address the health and wellness needs of vulnerable and low-income individuals. Consequently, a state cannot introduce measures that would deprive these individuals of care or lessen the quality or access to care simply to save money. All proposed revisions are reviewed for compliance with this standard, and examples of some of the effects the government expects to see are plans or measures that:

  • Promote efficiencies that will sustain benefits long-term;
  • Improve access to high-quality services that will create positive health outcomes; and
  • Provide new delivery systems and payment models to enhance network provider availability.

Nursing Home Coverage

The pivotal question, of course, for those in need of nursing home care, is how to qualify for Medicaid benefits. Paying for a long-term stay at a nursing home can quickly and easily drain a person’s life savings, but Medicaid is a welfare-based program that requires few assets and little income to qualify. An experienced Medicaid attorney can explain the complicated formulas used to calculate which property is countable, and ways to plan for Medicaid eligibility in advance, which allows an individual to protect their assets. Nevertheless, here are some basic eligibility requirements all Medicaid recipients are expected to meet:

  • Nursing home care is necessary, which is evaluated based upon the person’s ability to function, e., perform personal care, walk, etc., and the amount of care needed to keep them medically stable.
  • Satisfy income and assets limits, which in Florida for 2018 is $2,250 per month in income for single and married applicants filing alone, and $2000 in assets for the applicant and $123,600 for the non-applicant spouse. The limits when both spouses file for Medicaid is $3,375 per month in income and $3,000 in assets. Note that both spouses are considered together for eligibility purposes, whether both seeking Medicaid coverage or just one, and can significantly alter what is permissible.

Get Legal Advice

Qualifying for Medicaid is no small feat, and an experienced Medicaid attorney can make a huge difference as to when benefits are available, and how many assets a person may keep. William Rambaum understands how crucial Medicaid coverage is, and can help you protect your financial legacy, as well as get the financial assistance you need for medical care. Contact the Oldsmar office today to schedule an appointment.



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