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Does Medicaid Cover Memory Care in Florida?

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Does Medicaid Cover Memory Care in Florida?

January 15, 2024
Geoff Hoatson

Witnessing Alzheimer's or dementia steal your loved one's independence is one of life's hardest battles. As their needs outpace your ability to care, exploring supportive options like memory care becomes a heartbreaking yet necessary consideration. 

However, the high costs of memory care can seem insurmountable, especially for families already dealing with significant emotional and physical burdens. If you find yourself in this difficult situation, you’re likely wondering, “does Medicaid cover memory care in Florida?” 

In this blog post, a Florida Medicaid lawyer from Family First Firm explains the Medicaid eligibility requirements in Florida and what the program can help cover when it comes to nursing home and assisted living memory care costs. Whether facing challenging decisions for a loved one or proactively planning for your own future, we’re here to help. Contact a member of our team at (407) 574-8125 to learn how, so you can focus on your loved one’s well-being instead of financial worries during this trying time.

You don’t need to go long-term alone!

What is Memory Care?

Memory care services go beyond traditional long-term care, offering specialized support for individuals experiencing Alzheimer's disease, dementia, and other cognitive impairments. These secure environments are designed to minimize confusion and maximize resident well-being. 

Trained staff provide round-the-clock supervision and assistance with daily living activities, while therapeutic programs and cognitive stimulation tools help maintain cognitive function and manage behavioral changes. Ultimately, memory care strives to create a supportive and compassionate environment where individuals with memory loss can maintain a high quality of life with respect and dignity.

Florida's Medicaid Program for Long-Term Care

Medicaid, a program with both federal and state contributions, offers a comprehensive approach to long-term support and for some memory care services in Florida through the Florida Medicaid Managed Care Long-Term Care Program (SMMC LTC). Once you meet Medicaid’s eligibility requirements, this program can provide multiple care options, including:

  • Nursing homes: Full coverage for skilled nursing care for individuals who meet nursing facility level of care requirements.
  • Home and Community-Based Services (HCBS) waivers: These waivers, like the iBudget and Community Care waivers, offer financial assistance for a wide range of services delivered in home and community settings, including memory care communities and assisted living facilities. Covered services may include personal care (bathing, dressing, medication management), supportive services (transportation, meal preparation, social activities), and some therapeutic services (cognitive stimulation, behavioral management).
  • Assisted living and memory care facilities: While Medicaid does not cover room and board in these facilities, HCBS waivers can subsidize a portion of personal care services.

Financial Considerations

Medicaid's contribution for memory care varies depending on the setting and services received. In nursing homes, Medicaid may cover most expenses. However, in assisted living or memory care communities, Medicaid's contribution through HCBS waivers typically ranges from $1,200 to $1,500 per month, covering only a portion of personal care services. Room and board, which makes up 70-80% of the average monthly cost of $8,000, remains the responsibility of the family. Costs can vary by region, with some areas as low as $5,000 per month.

Waiting List

Due to the high demand for services, there is often a waiting list for both nursing homes and HCBS waivers. Priority is given to those with the most critical medical needs, and the waiting period can vary between six months to two years depending on the region and specific program.

Alternative Funding Options

Here are some other options to consider for memory care funding.

Long-Term Care Insurance

If you have a long-term care insurance policy, it may cover memory care services. Policies vary, so you need to check your specific plan benefits for coverage details related to memory care facilities.

Veteran's Benefits

Veterans and their spouses may be eligible for benefits through the Veterans Administration. The Aid and Attendance benefit is one program that can help cover the cost of memory care.

Private Pay and Personal Assets

Paying out-of-pocket, known as private pay, often involves utilizing savings, retirement accounts, or other assets. This can include selling or renting out property. It's essential to plan ahead to ensure sufficient funds are available when they're needed.

Immediate and Proactive Support with an Attorney

Whether your loved one's immediate need for memory care has ignited a whirlwind of decisions, or you're contemplating your own future long-term care needs, an experienced Medicaid and Elder Law Attorney can be your invaluable guide and advocate. Let's explore how their expertise can assist you at different stages of the journey:

Immediate Action and Peace of Mind

If you’re facing a time-sensitive situation where your loved one requires memory care right away, here are some immediate steps an attorney can take to expedite access to crucial care and ease your burden.

  • Fast-Track Application Process: Attorneys familiar with Florida's Medicaid regulations can ensure a swift and error-free application, significantly reducing delays and expediting access to critical care.
  • Maximize Benefits and Minimize Denials: With their in-depth knowledge of eligibility requirements and asset thresholds, attorneys can strategically navigate your financial situation to secure the maximum possible benefits while minimizing the risk of denials.
  • Address Urgent Financial Concerns: Time might be of the essence. Attorneys can help you understand and navigate any asset transfer restrictions or financial hurdles that might impede eligibility, offering creative solutions to overcome potential roadblocks.
  • Proactive Advocacy and Representation: Your attorney will become your loved one's voice, effectively advocating their needs and rights during interactions with Medicaid agencies, ensuring their concerns are heard and addressed with diligence.

For further reading, we invite you to read our blog, “My Parents Need Medicaid. How Can I Apply For Medicaid In Florida On Their Behalf?

Proactive Planning for the Future

An attorney also plays an essential role in helping you proactively plan for your own future incapacity. Here’s how an attorney can help you with Florida Medicaid Planning:

  • Legal Guidance and Strategy: Gain a clear understanding of Florida's specific Medicaid eligibility requirements and formulate a long-term care plan that doesn't jeopardize future eligibility.
  • Application Assistance: Eliminate application stress. Your attorney will ensure your Florida Medicaid application is accurately completed and filed, reducing the chance of delays or denials due to errors.
  • Asset Protection: Attorneys meticulously review your financial situation to identify which assets could affect your Medicaid eligibility.
  • Exempt Assets: Gain clarity on which assets, like your primary residence or personal effects, are exempt from consideration.
  • Non-Exempt Assets: Develop strategies to manage non-exempt assets that could disqualify you from receiving benefits, potentially involving legal instruments like trusts to lawfully align your assets with eligibility requirements.
  • Appeals and Hearings: In rare cases of denied applications, your attorney can represent you in the appeals process, advocating on your behalf with meticulous preparation and diligent hearing attendance.

Remember, every family's situation is unique. An attorney can tailor their approach to your specific circumstances, ensuring you receive the crucial guidance and support you need, whether facing immediate challenges or proactively planning for your future. Don't hesitate to seek legal counsel for peace of mind and a smoother journey towards secure and affordable memory care.

Additional Resources and Support

When exploring Medicaid coverage for memory care in Florida, you have access to state programs and local resources designed to support both the individual in need and their caregivers.

State Programs and Assistance

Florida offers specific programs to assist individuals with memory care needs. The Comprehensive Medicaid Waiver includes provisions for home and community-based services. To find out if you qualify, contact the Florida Department of Elder Affairs or visit the Statewide Medicaid Managed Care website. Below is a list of relevant services and their contact information:

Caregiver Support and Community Resources

Community outreach and caregiver support are essential when caring for someone with memory issues. Your local Area Agency on Aging can give you information about support groups and services. The Alzheimer's Association provides resources specific to memory care, including education, support groups, and a 24/7 helpline. Consider these resources:

Find Out How Medicaid Can Help With Memory Care Costs

Facing the complexities of memory care and Medicaid eligibility can feel overwhelming. But you don't have to go through this journey alone. Our team of dedicated Medicaid and Elder Law Attorneys at Family First Firm is here to guide you every step of the way.

If you're seeking financial assistance provided by Medicaid for memory care, reach out to us at (407) 574-8125 or simply fill out our online form to schedule your consultation. Our team is committed to answering your questions, understanding your specific circumstances, and safeguarding yours or your loved one’s assets. 

A Florida Medicaid lawyer from our team will guide you through every stage of the Medicaid process, including document collection and the preparation of wills, trusts, deeds, contracts, and more – all without incurring additional charges. We will also facilitate the coordination of benefits with your chosen care facility. Experience the difference with Family First Firm – dedicated Medicaid & Elder Law Attorneys.

At Family First Firm, you don’t need to go long-term alone!

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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