Criteria for Qualification – 2015

Medical Issue

  • Evaluation by CARES Unit (Department of Elder Affairs)
    Issue: Is the placement in a 24 hour-a-day, 7 day-a-week skilled nursing facility necessary.
  • Speak with family doctor or assisted living facility personnel.
  • Mere dementia is not enough; custodial care needs are not “skilled” care.

Monthly Income Limits

  • Medicaid Applicant’s (MA) income cannot exceed $2,199.00 gross income per month.
    If income exceeds $2,199.00 gross income per month, then a qualified income trust (QIT) must be established and the bank account funded in the month of application and ongoing.
  • If Medicaid Applicant (MA) is married, the spouse’s income is NOT available for eligibility purposes. Spouse’s income is only considered after MA qualifies and for purposes of diversion of some of MA’s income to the community spouse (aka well spouse) at home for expenses.
  • Income includes social security, civil service, pensions, VA pension, interest, annuity income and mortgage income annuity income.

Total Assets Limits

  • “Countable assets” = savings accounts, checking accounts, money market accounts, certificates of deposit, stocks, corporate and municipal bonds, U.S. savings bonds, real property other than homestead (includes instate and out-of-state real property), limited amounts of whole life (cash value less than or equal to $2,500).
  • “Exempt Assets” = Homestead property, 1 automobile, household furnishings, wedding ring, burial space, prepaid funeral contract, designated burial fund account ($2,500 maximum) or funeral trust ($15,000 maximum), unlimited amounts of term life insurance.
  • Medicaid Applicant’s assets cannot exceed $2,000 + “exempt” assets.
  • If Medicaid Applicant is married, and applying for nursing home (ICP) program, the community (aka well-spouse or at home spouse) spouse’s assets may be an additional $119,220 + exempt assets.
  • If the community spouse’s assets produce very little income (less than $1939 per month), he or she may receive income from the institutional-ized spouse and if a shortfall exists, the community spouse may be entitled to a greater Community Spouse Resource Allowance (CSRA) (up to $2,931) through appeal processes.


  • Transfers between husband and wife or wife and husband are unlimited and do not create a penalty period.
  • Transfers or gifts made to anyone other than a spouse within the last 5 years result in a penalty period. If a penalty period is imposed by DCF, then no Medicaid benefits will be paid during the penalty period.
  • Calculation of Penalty period-take the value of all gifts that fall within the penalty period and divide by $7,638. Suppose that the total gifts equal $15,276, and then dividing $15,276 by $7,638 would be a 2 month penalty period.
  • A Medicaid Application is now required to be filed in order to trigger a penalty period. New rule effective 11/01/2011.
  • A penalty period can only be triggered if an individual is “otherwise eligible” for Medicaid. New rule effective 11/01/2011.

Proper Legal Documents for Medicaid Situation

  • Durable Powers of Attorney-there are many forms of Durable Powers of Attorney (DPOA) available from attorneys, the internet and, even, Office Max, Office Depot and Staples. The problem with these DPOAs is that they do not contain the proper language in them, they may not have enough alternates named and the alternates may not qualify. It is only advisable to obtain a Durable Power of Attorney including Medicaid language from an attorney that does substantial work in the Medicaid field.
  • Last Will and Testament-each party should have their wills reviewed to eliminate any possible problems. It is particularly important that the community spouse does not leave all of his or her assets to the institutionalized spouse. This could cost the institutionalized spouse his or her right to receive Medicaid benefits for a period of time. Potential problems could result if the wrong personal representatives are named in the will.
  • Designation of Health Care Surrogate (most hospitals and nursing homes will offer the use of their form). It is best to have your forms in place long before they are necessary. This is not the time to make snap-judgments and counseling may be needed to assure that you are making wise decisions
  • Living Will-this document usually says that you do not want artificial means to be employed to prolong your life. In Florida, we have seen the perils of not having a living will. (Remember Terri Schiavo?)

Should you complete the Medicaid Application yourself?

  • Simply stated, the answer is “No”, “No”, and “No”.
  • There are no instructions to explain how to fill-out the form. This results in many hidden traps that must be avoided.
  • Even a retired attorney was fooled into thinking he could fill-out the form. He got a “first-look denial” of benefits for his friend.
  • Medicaid workers, at most offices, don’t know how to fill-out an application.
  • Remember, it is the function of the Medicaid office to deny you benefits that you are entitled too! It can become very adversarial at times.
  • Medicaid wins when you get frustrated with the system and drop your claim for benefits.
  • The private pay rate for a local nursing home is anywhere from $7,000 to $10,000 per month depending upon services needed. Mistakes can be very costly.

10 signs your Home and Money are at Risk

  1. You think Medicare pays for all medical conditions, even ones that last for more than 90 days.
  2. You think Medicare Supplemental Insurance pays for Long Term Care.
  3. You think your Primary Health Insurance Company pays for Long Term Care.
  4. You have not purchased any Long Term Care Insurance.
  5. You think a Revocable Living Trust protects your assets from a Medicaid Recovery Lien. In reality, it all counts against the applicant’s assets.
  6. You think you can qualify for Medicaid by giving away your home.
  7. You think you can qualify for Medicaid by giving away your assets.
  8. You do not have a healthcare Power of Attorney or Designation of Health Care Surrogate.
  9. You do not have a financial Durable Power of Attorney with proper Medicaid language in it.
  10.  You do not have a proper Living Will with a HIPAA Waiver.

Planning Techniques

  1. There are several income planning techniques that may be properly employed if the Medicaid Applicant’s income is too high.
  2. There are over two dozen asset planning techniques that may be properly employed if the Medicaid Applicant and/or the Community Spouse’s assets are too high.
  3. Medicaid workers and non-Medicaid attorneys will tell you to spend down your assets or that you do not qualify for Medicaid assistance. Be very wary of this advice.
  4. A qualified and experienced Medicaid attorney can save you time and trouble by guiding you through the system and saving you additional dollars for yourself and your family.
  5. It is always best to plan at the first symptoms of a serious illness as more options will be available to protect your assets.
  6. Waiting too long may result in the need for a legal guardian to be appointed to represent you and this is an extremely expensive procedure ($5,000 or more) with someone else (a judge) making your decisions for you.