
In Florida, the average annual cost of a private room at a long-term
nursing facility now hovers upwards of $90,000 annually, with a semi-private room around $83,000. With the oldest Baby Boomers
turning 70 and the escalating incidence of chronic and extraordinarily expensive
diseases such as Alzheimer's, more and more families face financial disaster
when a loved one needs long-term care. It is fair to say that this is a national crisis, but one our political leadership is not yet seriously addressing. For the foreseeable future, America's
families are on their own.
If a family lacks the extensive financial resources necessary to
cover long-term care costs, or if a person needing care has failed to obtain, or
has not been able to qualify for or afford long-term care insurance, Medicaid
is often a viable option. Securing Medicaid benefits for long-term care in a
nursing home can preserve a good portion of a family's assets before virtually
everything is lost to nursing home costs. Obviously, preserving assets
is especially critical when the person needing care is married, so that there are sufficient funds left for the spouse to live on.
With this in mind, below I address some of the most common
myths about Florida Medicaid benefits for long-term care. The list is by no
means exhaustive, but is a good starting point if you are
concerned about how to pay for your own or a loved one's long-term care, whether you're planning in
advance or facing an immediate crisis.
MediCARE covers long-term nursing care.
False! Medicare covers only skilled nursing care, and even then, only for a limited period of time
following a three-day hospital stay. In contrast, long-term care is custodial care. It is not intended
to make a person "better." Its goal is to help a person with activities of daily living such as bathing, eating, toileting. Medicare does not cover long-term care. If you or your loved
ones are relying on Medicare to cover long-term care
expenses, think again.
Once you are in a long-term care facility, it is too late to
take any steps to preserve assets and obtain Florida Medicaid.
False! While it is always better to plan in advance, that is not how things generally unfold in the real world. Most often, we assist families with crisis planning, i.e., when a loved one is already in, or about to enter, a nursing home. Even at that point, a variety of techniques can help preserve assets.
You must spend down and become totally impoverished before
applying for, let alone becoming eligible for Medicaid.
False! Spending down is just one method of becoming Medicaid eligible. Numerous other methods may be available that do not involved dissipating one's assets. In fact, many times we are able to assist families who have been privately paying a nursing home for months or longer because they did not realize there was an alternative to spending down.
Any transfers made within five years of applying will make
you ineligible for Medicaid for five years.
False! This myth is based on an incomplete and incorrect
understanding of Florida's
Medicaid rules. Any uncompensated or below-market-value transfers will be
considered by the Medicaid office when it examines the application. These
transfers will be used to determine a waiting period during which Medicaid benefits will not be available and the applicant will have to pay privately. But that does not mean
you have to wait five years to apply. More importantly, some
transfers are exempt and will cause no delay in obtaining Medicaid.
Florida's Medicaid rules are the same as the rules in other states.
False! Medicaid
is a federal program, but because each state also participates financially
in Medicaid funding, there are many areas in which the rules vary from state to
state. A friend's experience in another state does not necessarily apply to Florida. And even in Florida, you can't
assume a rule that applied last year is true this year, because the rules
change from time to time.
Long-term care facility residents on Medicaid receive inferior care compared to private pay residents.
False! Federal law prohibits nursing facilities from
discriminating against a patient based on source of payment. In all
my years working with clients who have loved ones residing in nursing homes, I have never
come across a situation where this has occurred. In fact, many of my clients'
families have been able to provide a greater quality of care for their loved one by using preserved assets to pay for part-time private duty care to supplement regular nursing home
care, as well as other "extras."
Medicaid rules let me give away $14,000 a year without
impacting eligibility.
False! This common misconception arises when Medicaid rules are confused with federal estate and gift tax rules. Under federal law, you
can give away $14,000 per year to as many people as you like without it
affecting your lifetime unified estate and gift tax exemption. However, this rule is completely unrelated to Medicaid rules. As far as Medicaid is concerned, any transfer for less than fair market value
is examined when the application is submitted, and
may be used to compute a penalty period during which the applicant will be
ineligible for benefits.
My spouse's assets and income won't matter if I apply for
Medicaid.
False! The assets and income of both spouses are considered. However, there are steps that may be taken to protect the assets of
the well spouse. In Florida
there is currently "spousal refusal" whereby a spouse has the right
to refuse to pay for a spouse's long -term care costs. My law firm has assisted
numerous families with this strategy.
If I am incapacitated, my agent under my Durable Power of
Attorney can do Medicaid planning for me in order to preserve assets.
Not necessarily! Your Durable Power of Attorney (DPOA) would
have to give the agent certain powers, including the power to make gifts. If a
DPOA does not confer these powers or is not executed properly and does not meet
all Florida
legal standards, your agent will not be able to perform these actions. You
would have to create and execute a new DPOA - which obviously would not be possible if, at that point, you lacked the requisite mental capacity. That is why it is always advisable to have a Florida Bar Certified Elder Law Attorney review your DPOA while you are competent, so that you can change it if necessary.
Assets in a living trust are protected from nursing home costs.
False! However, there are certain kinds of trusts - for
example, a Medicaid Asset Protection Trust which, if done in advance and
properly structured, may preserve assets.
I can just "hide" assets so Medicaid doesn't know they exist.
False! This is a crime. You could be charged with fraud. Any "advisor" who suggests hiding assets is giving you bad advice. There are
many perfectly legal ways to restructure and move assets that can hasten
Medicaid eligibility and preserve a good portion of assets. No other approaches
should be taken.
I will lose my house if I get Medicaid benefits.
False! Under Florida
law, your homestead is a protected asset if the equity is under $552,000. It cannot be taken away during your lifetime. Nor is it subject to Medicaid
recovery upon your passing, if it is left to your constitutional heirs at law.
I don't need an attorney to help with Medicaid planning.
False! Florida Medicaid law is complicated. Any mistakes you make with
regard to transfers and assets can be costly ones. Rely on a Florida Bar Certified
Elder Law Attorney such as myself to guide you through the process.