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Does Medicaid Cover Skilled Nursing Facilities in Florida?

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Does Medicaid Cover Skilled Nursing Facilities in Florida?

May 15, 2024
Geoff Hoatson

Whether you're a Florida senior or just starting out on your financial journey, it's crucial to understand the financial implications and the importance of protecting your assets should you need skilled nursing or long-term care.

This is because the costs of skilled nursing and long-term care are staggering. In Florida, the average monthly cost of a semi-private room in a skilled nursing facility is greater than $13,000, which can rapidly deplete your family's financial resources. Fortunately, there are government-funded programs that can help alleviate the financial burden for those who qualify

In this blog, we'll answer the question, "does Medicaid cover skilled nursing facilities in Florida?" We'll also discuss what skilled nursing facilities are, how they differ from long-term care, and the critical role Medicaid plays in making this essential care accessible to those who need it most. We'll also delve into the importance of early Medicaid Planning and how working with an experienced Medicaid Planning attorney can help you protect your assets and secure the care you or your loved one needs should you require a stay in a skilled nursing facility. 

Defining Skilled Nursing Facilities

Skilled nursing facilities (SNFs) are specialized healthcare institutions that play a crucial role in providing short-term, post-acute care for patients transitioning from hospitalization to home. These facilities serve as a bridge between hospital care and returning home, offering a comprehensive range of medical services and resources to support patients during their recovery process.

Distinction from Long-term Care

Unlike long-term nursing homes, which cater to individuals requiring ongoing assistance with daily living activities, SNFs focus on intensive, short-term rehabilitation and medical care. While some patients may stay for about 20 days to a few weeks, the duration of stay can vary widely based on individual needs and medical complexity.  That said, most SNFs also have a long-term care part of the facility for patients who will never be able to return home.

Multidisciplinary Care Team

At SNFs, patients have access to a multidisciplinary team of healthcare professionals, including:

  •  In-house doctors for medical care
  •  Licensed nurses for monitoring and treatment administration
  •  Physical, occupational, and speech therapists for targeted rehabilitation services
  •  Social workers for care coordination and discharge planning

Specialized Services

Skilled nursing facilities offer a wide range of specialized services, including:

  • Wound care
  • IV medication administration
  • Post-surgical care and rehabilitation
  • Respiratory therapy
  • Dialysis

Continuity of Care

While SNFs are not hospitals, some are affiliated with larger healthcare systems or hospitals, ensuring seamless continuity of care for patients transitioning from acute to post-acute settings.

It is important to note that skilled nursing facilities are distinct from assisted living facilities, which are designed for individuals who need some assistance with daily tasks but do not require round-the-clock medical care. Additionally, while some nursing homes may offer short-term rehabilitation services, their primary focus is on providing long-term care for residents who can no longer live independently.

Does Medicaid Cover Skilled Nursing Facilities in Florida?

Whether you’re facing the need for a stay at a skilled nursing facility now or in the future, you likely have questions about the financial aspect and whether your healthcare coverage will support the costs involved. While Medicare is often associated with covering healthcare expenses for seniors, its coverage for SNF care has limitations. Let's delve into the roles of both Medicare and Medicaid in covering SNF care and explore the specific considerations for Florida residents.

Medicare Coverage for Skilled Nursing Facilities

  • Medicare Part A typically covers up to 100 days of SNF care per benefit period, but certain criteria must be met, including a prior hospital stay of at least three days and the need for skilled nursing or therapy services.
  • While Medicare covers the full cost of SNF care for the first 20 days, you’ll pay $204 for days 21 - 100 and all costs after day 100.

Medicaid Coverage for Skilled Nursing Facilities

  • Medicaid, a joint federal and state program, provides health coverage to eligible low-income individuals and families, including long-term care services such as nursing home care and, in many cases, SNF care.
  • In Florida, Medicaid may cover the cost of SNF care for individuals who meet the program's eligibility criteria, which typically include income and asset limits.

Key Considerations for Florida Residents

  • Dual Eligibility: Some individuals may qualify for both Medicare and Medicaid, often referred to as "dual eligible." Dual eligibility may provide additional coverage options and financial assistance for SNF care.
  • Long-Term Care Needs: While Medicare covers SNF care for a limited time, Medicaid may provide coverage for longer-term care needs, especially for individuals requiring extended stays in SNFs beyond what Medicare covers.
  • Application Process: Understanding the eligibility criteria and application process for Medicaid in Florida is crucial for individuals seeking coverage for SNF care. This may involve income and asset assessments and navigating the complexities of Medicaid enrollment.

While Medicare offers coverage for short-term SNF care under specific conditions, Medicaid may provide essential support for individuals requiring longer-term or extended SNF stays, particularly for those with limited financial resources. Exploring both Medicare and Medicaid options and understanding their respective roles can help you make informed decisions about your healthcare coverage needs for SNF care.

The Medicaid 5-Year Lookback Period: Why Early Planning is Crucial

The 5-year lookback period is a critical aspect of the Medicaid application process. When you apply for Medicaid, the government will review your financial transactions over the past 5 years to ensure that you have not transferred assets for less than fair market value in an attempt to qualify for Medicaid. This means that any gifts, donations, or asset transfers made within the 5 years prior to your Medicaid application will be closely scrutinized.

Consequences of Improper Asset Transfers

If Medicaid determines that you have made improper transfers during the lookback period, you may be subject to a penalty period. During this time, you will be ineligible for Medicaid coverage, even if you meet all other eligibility requirements. The length of the penalty period is calculated based on the value of the assets transferred and the average cost of nursing home care in your area. For example, if you transferred $100,000 in assets, and the average monthly cost of nursing home care in your area is $5,000, your penalty period would be 20 months ($100,000 ÷ $5,000 = 20).

The consequences of triggering a penalty period can be severe. Without Medicaid coverage, you may be forced to pay out of pocket for skilled nursing facility care, which can quickly deplete your life savings. Alternatively, you may have to forgo necessary care altogether, potentially compromising your health and well-being.

The Importance of Early Medicaid Planning

To avoid these negative outcomes, it is crucial to engage in Medicaid Planning well before you reach 65 or anticipate needing a stay at a skilled nursing facility or long-term care. By working with a skilled Medicaid Planning attorney early on, you can structure your assets in a way that complies with Medicaid rules and regulations while still protecting your wealth and ensuring your eligibility for coverage when you need it most.

However, even if you find yourself needing skilled nursing facility care and have missed the window of the 5-year lookback period, there may still be strategies available to help you qualify for Medicaid. An experienced Medicaid Planning attorney can assess your situation and determine the best course of action.

The Value of a Medicaid Planning Attorney

Navigating Complex Medicaid Rules

Medicaid rules and regulations can be complex and confusing. A skilled Medicaid Planning attorney can help you understand the Medicaid eligibility requirements and how they apply to your specific situation. They can also guide you through the intricacies of the 5-year lookback period and help you avoid costly mistakes that could jeopardize your eligibility.

Protecting Your Assets

One of the primary goals of Medicaid Planning is to protect your hard-earned assets while still qualifying for the coverage you need. Your attorney can help you develop a comprehensive plan to structure your assets in a way that complies with Medicaid rules and regulations. This may involve strategies such as creating trusts, transferring assets to family members, or converting countable assets into exempt resources.

Assistance with the Medicaid Application Process

Applying for Medicaid can be a daunting task, with numerous forms to complete and documentation to provide. A Medicaid Planning attorney can guide you through the application process, ensuring that all necessary information is included and that your application is submitted correctly. They can also help you respond to any requests for additional information or clarification from the Medicaid office.

Appealing Denied Benefits

If your Medicaid application is denied, a Medicaid Planning attorney can help you navigate the appeals process. They can review the reasons for the denial, gather additional evidence to support your case, and represent you in any hearings or legal proceedings. Having an experienced advocate on your side can increase your chances of a successful appeal and ultimately obtaining the coverage you need.

Exploring Alternative Payment Options

In addition to helping you qualify for Medicaid, a Medicaid Planning attorney can also explore other options for paying for long-term care. This may include reviewing your eligibility for Veterans benefits, considering long-term care insurance, or exploring other financial resources. By taking a comprehensive approach to your long-term care needs, your attorney can help you develop a plan that maximizes your coverage and minimizes your out-of-pocket expenses.

Get the Skilled Nursing Care You Need Without Sacrificing Your Financial Future

No one expects to need skilled nursing care, but unfortunately, recovering from an illness or accident may require a stay in a skilled nursing facility. At such a challenging time, the last thing you want to worry about is how to pay for the care you or your loved one needs.

At Family First Firm, we understand the emotional and financial toll that unexpected skilled nursing facility care can take on families. That's why our compassionate and knowledgeable Medicaid Planning attorneys are here to guide you through the complex process of securing Medicaid coverage for skilled nursing facilities in Florida.

Our team of dedicated professionals has a deep understanding of Florida's Medicaid programs and the intricate rules surrounding eligibility and asset protection. We work closely with you to assess your unique situation, develop a personalized plan, and help you navigate the application process with confidence.

Whether you need assistance with establishing eligibility, structuring your assets to comply with Medicaid rules, or appealing a denial of benefits, our experienced attorneys are here to support you every step of the way. We believe in empowering our clients with clear, concise information and providing the guidance needed to make informed decisions.

Schedule your consultation today with one of our knowledgeable Medicaid Planning attorneys and their Medicaid specialists team to discuss your options and learn how we can help you secure the coverage you require while safeguarding your hard-earned assets. So, if you’ve been searching online for a “Medicaid lawyer near me,” connect with Family First Firm instead by calling (407) 574-8125. If more convenient, you can complete our online form to take the first step towards peace of mind and the quality care you need.

Protect Your Legacy. Contact Family First Firm – Your Elder Law Experts. 

Copyright © 2024. Family First Firm - Medicaid & Elder Law Attorneys. All rights reserved.
The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country, or other appropriate licensing jurisdiction.
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