How to Qualify, Obtain and Maintain Medicaid Benefits

Ruth C. Rhodes • November 7, 2022

The average nursing home costs in Florida might shock you. As a senior needing nursing home care, you'll need to be prepared to pay between $8,654 and $9,627 monthly.

As seniors near the end of their lives, often those amounts are insurmountable. They could never have saved enough to afford this potential cost. This is especially true because you can never know how long you'll need this type of care.

What does a senior do when their Medicare stops paying but needs to remain with nursing home care? For many, it means turning to Medicaid.

Medicaid benefits can be so important for those in need. It's essential to consider Medicaid planning in Melbourne, FL, for the future. Read on to learn more about Medicaid benefits in Florida.

Medicaid in Florida

It's important to understand the basics of Medicaid because it's a wide-sweeping program providing important services for many people who need it.

Medicaid in Florida is a state and federal program providing health care services for low-income individuals in the state.

Medicaid provides services for many in need, including:

Pregnant women
Children
Senior residents needing long-term care

Medicaid helps seniors to pay for care in nursing homes, adult foster care homes and assisted living facilities. They also provide some necessary funding for non-medical needs for seniors in need who are homebound.

How Are Medicaid and Medicare Different?

When considering seniors needing assistance, many confuse Medicare vs. Medicaid. It's not uncommon for people to assume the two are the same.

While both can provide important services for seniors, they are not the same.

Medicare is an entitlement program developed for seniors and some disabled citizens. You become eligible for Medicare at age 65 if you've been paying into the system while working.

So, how is Medicaid different? Medicaid is a need-based program. It can help seniors and those with a disability with long-term care beyond the scope of Medicare.

Instead of age and paying in like with Medicare, you're eligible for Medicaid based on financial need and your medical necessity/disability.

Income and Asset Limits for Florida Medicaid

To qualify for Medicaid, you must meet a series of criteria through the State of Florida and the federal government.

First, you must meet age, citizenship, and residency requirements. Next, if you need care from a nursing home, you must be disabled, blind, or of advanced age.

You'll need to show that you need a nursing home level of care. The Department of Elder Affairs (Cares Units) is part of the assessment for eligibility.

Medicaid Planning

To obtain Medicaid and maintain Medicaid benefits, you must be prepared to jump through some hoops when applying. Many people who anticipate a future need will do Medicaid planning to set up their finances, so they support Medicaid eligibility.

Medicaid planning might include:

Spending down your assets, then buying replacement assets that are not counted toward Medicaid asset limits
Transferring assets to your children
Transferring assets to a spouse who doesn't need long-term care
Creating a Medicaid-qualifying income trust (a "Miller Trust")

You might also be able to create a Florida Medicaid trustor to shield some income or assets while you're in long-term care.

Get the Help You Need With Medicaid Planning in Melbourne, FL

Programs like Medicaid are important when you need care the most. They're especially important to those who can't pay for long-term care themselves.

If you anticipate the need for Medicaid planning in Melbourne, FL, we can help. Let us use our experience and knowledge to guide you through the process. Contact us today to get started.

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Medicare and Medicaid...What's The Difference?

May 9, 2025

Medicare and Medicaid are both government-run health insurance programs in the U.S., but they serve different groups and are funded differently: Medicare - Who it's for: Primarily for people 65 and older, and some younger people with disabilities or end-stage renal disease. - Funded by : Federal government , through payroll taxes, premiums, and general revenue. - Coverage : Includes hospital care (Part A), medical services (Part B), and optional prescription drug coverage (Part D). Private Medicare Advantage plans (Part C) are also available. Medicaid Who it's for : People of any age with low income , including children, pregnant women, elderly adults, and people with disabilities. Funded by : Jointly by federal and state governments. States run their own programs with federal guidelines. Coverage : Broader than Medicare in many cases, often including things like long-term care, dental, and vision services. In short: Medicare = Age-based or disability-based, federal program. Medicaid = Income-based, state and federal program. Medicaid is usually low-cost or free , but costs can vary depending on your state, income, and the type of services you use. Here's a general breakdown: For Most People No monthly premiums Very low or no copays No deductibles In Some States Higher-income enrollees (still within Medicaid limits) may have: Modest monthly premiums (typically under $50) Small copays (often $1–$4 per visit or prescriptions For Long-Term Care (like nursing homes) Medicaid may require you to spend down assets or contribute most of your monthly income toward your care, depending on your financial situation. Special Programs: Children (CHIP or Medicaid) : Often completely free. Pregnant women and people with disabilities : Usually receive coverage with little to no cost. Engaging in Medicaid planning well in advance can significantly enhance peace of mind for individuals and their families, ensuring they make informed decisions that align with their long-term goals. Legal and financial advice may be needed to effectively manage an individual’s estate. Creating trusts, gifting assets, or employing spend-down strategies are often utilized to align with Medicaid’s requirements. At Rhodes Law, P.A. , Ruth will advise you how to qualify, obtain and maintain Medicaid benefits. Call our office at (321) 610-4542 and schedule your consultation today!

Is It Neccessary to Have Both a Will and Trust?

April 30, 2025

If you have just a will and no trust , your estate can still be passed on according to your wishes—but there are some limitations and consequences you should understand: What Happens with Just a Will: Probate Is Required A will must go through probate , which is a court-supervised process of validating your will, paying debts, and distributing assets. Probate can: Take months or even years. Be expensive (court fees, attorney fees). Be public (anyone can view the will and estate details). 2. Court Control Over Distribution The probate court oversees how and when your assets are distributed. This means less privacy and flexibility. 3. No Ongoing Asset Management A will only takes effect after your death . It doesn’t help manage your assets if you become incapacitated. A trust, on the other hand, can provide for you during incapacity without needing a court-appointed guardian or conservator. 4. Less Control Over Complex Distributions If you want to delay inheritance (e.g., give children money at age 25 instead of 18) or provide ongoing support (e.g., for a special needs child), a trust is better suited. A will can't manage distributions over time—it just transfers ownership. 5. Tax and Asset Protection Limitations A will doesn't offer any real protection against estate taxes, creditors, or lawsuits. Certain types of trusts can. When a Will Might Be Enough: You have a very simple estate . Your total assets are below your state’s probate threshold . You have no minor children and no complex distribution needs. You’re okay with the probate process and your wishes are relatively straightforward. So, yes, even if you have a trust, you should also have a will . A trust and a will serve different but complementary purposes in estate planning. Think of the trust as the main tool for managing and distributing your assets, but the will as a safety net to ensure everything is covered. Rhodes Law, P.A. offers a comprehensive range of professional estate planning services that include wills, trusts, durable powers of attorney, designation of healthcare surrogates, living wills and more. Give our helpful estate planning professionals a call today at (321) 610-4542 to book a free consultation!

What You Need To Know About Medicaid!

March 13, 2025

Medicaid is a federal and state-funded program that provides health insurance coverage to low-income individuals and families. It is designed to help people who might not otherwise be able to afford healthcare, including certain groups like children, pregnant women, seniors, and individuals with disabilities. Medicaid programs are managed by each state, so the specific benefits, eligibility requirements, and application process can vary depending on where you live. Key Things You Need to Know About Medicaid: Eligibility for Medicaid: Medicaid eligibility is typically based on factors such as income, household size, and specific circumstances. In general, eligibility is determined by: - Income: Medicaid is designed for low-income individuals, and eligibility is often based on the Federal Poverty Level (FPL). If your income is below a certain threshold, you may qualify. - Age and Health Status: Some groups are automatically eligible, such as: Children Pregnant women Seniors (65 or older) People with disabilities - Family and Household Size: Medicaid eligibility also considers the size of your household and your family members’ income. - Expanded Medicaid: Under the Affordable Care Act (ACA), many states expanded Medicaid to cover individuals with incomes up to 138% of the FPL. Some states have opted not to expand Medicaid. Benefits Covered by Medicaid: Medicaid provides a comprehensive range of health services. While states are required to cover certain mandatory benefits, they also have the option to cover additional optional benefits. Common services covered by Medicaid include: - Doctor visits - Hospital services - Prescription drugs - Laboratory tests and X-rays - Emergency services - Mental health services - Rehabilitative services (like physical therapy) - Dental and vision care (in some states) - Maternity and newborn care - Home and community-based services (for people with disabilities or the elderly) - Preventive care: Vaccines, screenings, and wellness visits. How Medicaid Works State-specific Programs: Medicaid is jointly funded by the federal government and states, but each state administers its own program with different rules. This means coverage and benefits can vary by state. Managed Care: In many states, Medicaid operates under a managed care system, where beneficiaries get their care through private health plans that are contracted by the state. Fee-for-Service: Some states still operate Medicaid on a fee-for-service basis, where providers are paid for each service they deliver. How to Apply for Medicaid Online or In-Person: You can apply for Medicaid online through your state’s Medicaid website, by phone, or in person at your local Medicaid office. Some states also have mobile apps to help with the application process. Application Process: During the application process, you'll need to provide information about your income, household size, and any other relevant details (like disability or pregnancy status). The state will determine your eligibility and notify you whether you qualify for Medicaid or other assistance programs like CHIP (Children’s Health Insurance Program). Special Enrollment Periods: Medicaid enrollment is open year-round, unlike other health insurance programs like those under the Affordable Care Act (ACA), which have open enrollment periods. Medicaid for Children (CHIP) Medicaid has a Children’s Health Insurance Program (CHIP) that provides coverage for children in families who earn too much to qualify for Medicaid but cannot afford private insurance. CHIP covers many of the same services as Medicaid and is available in every state. Medicaid for Pregnant Women In many states, pregnant women with low income can qualify for Medicaid, regardless of their immigration status. Medicaid helps cover prenatal care, labor, delivery, and postpartum care, including health services for the baby. Income and Asset Limits Medicaid uses both income and assets to determine eligibility. Each state may have different income and asset limits, and some states may allow a spend-down for people with income just above the threshold. This means you may be able to deduct certain medical expenses to qualify. Medicaid and Medicare If you're eligible for both Medicaid and Medicare (the federal health insurance program for those 65+ or with disabilities), you're considered dual-eligible. Medicaid can help cover costs that Medicare doesn't, such as premiums, co-pays, and certain services not covered by Medicare (like long-term care). Cost and Coverage No Premiums: Most Medicaid recipients don’t have to pay premiums for coverage, although some states may charge a small premium for certain services or individuals with higher incomes. Out-of-pocket Costs: Depending on your state, you may be required to pay small copayments for services, but they are generally low compared to other insurance plans. Additional Coverage: Medicaid often covers essential services that may not be available with private insurance, like long-term care (nursing homes or in-home care). Medicaid for Long-Term Care Medicaid is the largest payer of long-term care services in the U.S., including nursing home care and home-based services for elderly individuals or those with disabilities. However, qualifying for long-term care benefits typically requires individuals to meet certain asset and income limits. Changing Medicaid Eligibility Eligibility for Medicaid can change due to changes in income, family status, or health condition. It’s important to update your information with the Medicaid office if there are any significant changes. Some states have yearly renewal processes to ensure people still meet the eligibility criteria. Important Considerations: Not All Providers Accept Medicaid: Some healthcare providers do not accept Medicaid, so it’s important to make sure your doctors or hospitals participate in the program. State-Specific Variations: As Medicaid is run by each state, the benefits, eligibility, and application process can vary. Be sure to consult your state’s Medicaid website or office for specific details. Sounds like a lot, right? Would you like to know more about Medicaid or how to apply? Contact Rhodes Law, P.A. at (321) 610-4542 and speak with Ruth C. Rhodes. She advises clients regarding how to qualify, obtain and maintain Medicaid benefits!