Medicaid Benefits Planning

Government Funding for Long-Term Care

The role of Medicaid planning in today’s economic climate is a vital one. Mary will assist family members in navigating the complex federal and state regulations concerning government benefits for long-term care. Because of the strict guidelines regarding the timing of transfers and the characterization of assets, the advice of an attorney should be sought out before any steps are taken to qualify a loved one for government benefits. At first glance the eligibility requirements for obtaining Florida Medicaid benefits for long-term care may appear fairly uncomplicated. Unfortunately, meeting the necessary requirements regarding coverage for long-term care can turn out to be quite complex, requiring the assistance of an experienced attorney. If you are attempting to secure Medicaid assistance there are specific income and asset requirements you or your loved one must meet.

What is Medicaid and How Can It Help?

For those individuals who require medical and/or nursing home treatment, Medicaid is a federal and state program which can significantly assist those who can show true need. Once qualified, a person may be eligible for the state of Florida to pay the difference between their monthly income and the monthly medical / care expenses. Benefits may be available for in-home and assisted living facility care and are always available for skilled nursing home care for those who qualify.

Medicaid Eligibility Requirements

If you meet the following requirements, you may be able to receive specific benefits for Florida Medicaid.

Age 65 or older, or blind or disabled.
Resident of the state of Florida.
Physical Limitations – you must need support with some daily living activities in order to be considered for Medicaid. Those activities may include needing help with walking and standing, feeding, getting dressed, bathing and performing basic toilet and hygiene functions.

Income and Asset Limits for Medicaid Eligibility

Keep the following information in mind when determining whether or not you or a loved one qualifies for Medicaid assistance: If you possess substantial assets, you may be able to make transfers or gifts in order to decrease your countable assets however you will then be subject to a five-year look back period from the date the asset(s) is transferred – meaning you will be responsible for your own or your loved one’s care bills until the five year penalty period from the date of the transfer has ended.

Income and Asset Requirements

The gross income of the person applying for Medicaid benefits in 2025 may not surpass $2,901 per month. When considering assets, the assets considered non-exempt may not exceed a value of $2,000. The spouse of a married applicant who resides in the same community is allowed assets up to the amount of $157,620 in addition to the exempt assets below.

Exempt Medicaid Assets

Your home (up to $730,000 in value) and one vehicle of unlimited value are exempt assets according to Medicaid. This means they do not count as assets and can be kept in addition to the $2,000 mentioned above for the person needing care and the $157,920 for the spouse in the community. There are additional exemptions. Please call Byrski Estate & Elder Law at (941) 833-9262 for a consultation to find out what else can be categorized as an exempt asset under Medicaid rules.

Strategies for Medicaid Qualification

9Unfortunately, many people desperately require Medicaid coverage in order to meet the considerable expenses of nursing home care, but will not immediately meet the asset and income test. These cases benefit the most from the services of a highly knowledgeable attorney who can develop strategies to allow qualification. These strategies may include the following:

Qualified Income Trust—Should the person applying for Medicaid have a gross monthly income that exceeds $2,901, an irrevocable qualified income trust (QIT), must be used in order to receive Medicaid. Once such a trust is created excess income (the amount over $2,901) must be deposited into a bank account set up in the name of the QIT each month. The Medicaid applicant’s monthly income is payable to the facility proving his/her care (this is called the “patient’s responsibility”). This includes including money moved to the QIT. However, the Medicaid applicant and/or his/her spouse may keep the following income:
- - A personal needs allowance in the amount of $160 is retained by the applicant.
  - For married applicants – if the spouse not applying for Medicaid has monthly gross income of less than $2,555 then some income from the Medicaid applicant may be diverted to the community spouse (the spouse not applying for Medicaid).
  - Some health insurance premiums.
The most crucial issue surrounding a Qualified Income Trust is management of the trust, meaning the income received monthly must be properly managed each month. Creation and implementation of the trust must be in place prior to the Medicaid application being processed.
Personal Service Contracts—One popular method of satisfying the asset eligibility test for Medicaid is through a personal service contract. This is most often necessary when the applicant’s assets exceed the allowable amount of $2,000 and exempt assets have been exceeded or are not an option. A service contract allows assets to be effectively transferred to a trusted family member or friend in exchange for services not provided by the nursing home or other facility. Such services could include personal shopping, visitation, paying and managing exempt assets and bills, and care coordination and meeting with facilities. Please note however that monies paid under a Personal Service Contract are taxable as income to the person receiving the payments.

Let us help you determine the best Medicaid planning strategy that will work for your particular situation. Please call us at (941) 833-9262 and schedule a consultation before you proceed with spending down, gifting away or retitling assets.