Medicaid Lawyer Serving Daytona Beach, Ormond Beach & Palm Coast, FL
Long-Term Care and Medicaid: Eligibility Issues
Families throughout Florida are struggling to keep up with the rising costs of long-term care for aging parents, spouses, and themselves. Even with careful retirement planning, most middle-class families aren’t prepared. At Selis Law Firm, our Medicaid lawyers in Daytona Beach, Ormond Beach, FL, and Palm Coast, FL, offer guidance for clients who need elder law or Medicaid planning assistance. We collaborate closely with our clients to fully understand their health, finances, lifestyle, and long-term care needs to determine eligibility for Medicaid benefits. We can also help you reduce your risk of an application or claim denial and help you navigate the Medicaid application process.
When and Why Do You Need a Medicaid Attorney?
You should meet with a Medicaid attorney if you have any confusion or questions about whether you qualify for Medicaid, how to apply for Medicaid, how to maximize Medicaid benefits, or how to deal with a Medicaid application or claim denial. An experienced Medicaid lawyer, like the ones at Selis Law Firm, can assist with pre-planning, applications, and the claims process to ensure you get the care you need when you need it most. They can also help you manage your finances to cover the costs associated with long-term care and other potential upcoming healthcare costs.
What Does a Medicaid Lawyer Do?
Although it’s not possible to apply for Medicaid benefits until the applicant meets the medical requirements, creating a preemptive plan can help reduce stress and confusion when the time comes for a loved one to enter a long-term care facility. Discover how our team can assist you.
Medicaid Pre-Planning
The need for Medicaid benefits can occur at a moment’s notice. Are you prepared? We can create a custom plan to maximize your benefit amount to ensure a smooth transition.
Semi-Crisis Planning
Many don’t realize the importance of planning until the moment arrives. It’s essential to discover how our legal team can help you protect your assets and income before you begin the application process.
Crisis Planning
A sudden health decline or unexpected illness may lead to the immediate need for long-term care. If you’re unprepared, the process can become complicated, drawn-out, and financially challenging.
Medicaid Denied Benefits
Eligibility requirements for Medicaid benefits are continuously changing, often leading to application mistakes. Our lawyer team can review your application and make corrections to get you the benefits to which you’re entitled.
Understanding Florida’s Medicaid Laws and Eligibility Issues
Medicaid is a federal and state program designed to provide healthcare coverage to low-income individuals and families. Florida’s Medicaid covers numerous services, including hospital stays, doctor visits, medications, and long-term care. The financial qualifications vary depending on numerous factors, including income limits, marital status, and who in your family is applying. Making mistakes during the application process or not fully understanding your eligibility status can result in a denied application or denied Medicaid claim. The most common reasons for denied applications or claims are:
- Eligibility issues like not being old enough, not having a qualifying disability, or not meeting residency requirements
- Missing information, such as failing to provide necessary documentation like proof of identity, proof of citizenship, or employment history
- A criminal background
- Past Medicare or Medicaid violations
- Healthcare provider exclusion due to past misconduct or other issues
Income, Asset Limits, and What You Can Legally Keep
Qualifying for Medicaid in Florida requires meeting strict financial eligibility guidelines. Yet many people misunderstand what counts against them, often fearing they’ll be left with nothing. In reality, several legal exclusions and strategic planning options exist that allow individuals to qualify for long-term care coverage while maintaining a degree of financial security.
Understanding the basics of Medicaid’s financial thresholds is key:
- Countable vs. Non-Countable Assets: Countable assets typically include cash, savings, investments, and secondary properties. Non-countable assets may include your primary residence (up to a certain value), one vehicle, personal belongings, and irrevocable burial funds. Knowing the difference can significantly impact your eligibility.
- Community Spouse Resource Allowance (CSRA): Under Florida Medicaid rules, a healthy spouse who remains in the community can keep a portion of the couple’s joint assets. This allows the institutionalized spouse to qualify without impoverishing the other partner.
- Spousal Refusal: In some cases, the community spouse may legally refuse to contribute certain assets to the applicant’s care. While this strategy must be carefully managed, it can offer an additional layer of protection.
- Fla. Admin. Code R. 65A-1.712: This regulation outlines the detailed eligibility requirements for Florida Medicaid, including asset and income tests.
- Fla. Stat. § 409.902: This statute defines Medicaid eligibility and the program rules to adapt based on federal and state changes. Staying updated on these laws is essential for preserving benefits.
Asset Transfers, Lookback Periods, and the Penalty Clock
One of the biggest pitfalls families encounter during Medicaid planning is misunderstanding the 60-month lookback period. Florida Medicaid examines all asset transfers made within five years of a Medicaid application to ensure no assets were gifted or sold below fair market value in an attempt to qualify.
Avoiding penalties requires planning and knowledge of how and when to transfer assets:
- The 60-Month Lookback Rule: Any asset transfer for less than fair market value during this period can result in a penalty, potentially delaying benefit eligibility. These delays can be financially devastating if long-term care is needed immediately.
- Penalty Period Calculations: The penalty is determined by dividing the value of the transferred assets by the average monthly cost of nursing care in Florida. This creates a period of ineligibility during which you must cover costs out-of-pocket.
- Permissible Transfers: Certain transfers are exempt from penalties, including those made to a spouse, a disabled child, or into specific types of irrevocable trusts. A Medicaid attorney can help identify transfers that comply with the law.
- Gift Missteps: Giving money to children as a “legacy” without proper documentation or structure may disqualify you from benefits. Seek legal advice before gifting any substantial assets.
- Correcting Prior Transfers: In some cases, improper transfers can be reversed or mitigated through legal avenues, shortening the penalty period and restoring eligibility.
Benefits of Working With an Expert in Elder Law and Medicaid Planning
Our team can help you unravel the legalese and challenges of the Medicaid program to ensure you understand your qualification status while helping you maximize your benefit amount. Attorney Scott A. Selis and his legal professionals have assisted countless clients throughout the state, and we’re confident we can help you, too. The benefits of working with our Medicaid lawyers are:
- Preparation for long-term care needs
- Protection from fraud
- Legal advice for complex situations like supplemental benefits and end-of-life planning
- A better understanding of your eligibility and coverage
- Maximized benefits
- Protection of assets during the Medicaid qualification process
- Resolution of disputes, such as denied applications or denied claims
Other Legal Services Provided by Selis Law Firm
In addition to providing Medicaid planning assistance and assistance with denied Medicaid benefits claims, we offer other elder law and Medicaid planning services. Call us now to schedule a consultation for any of our other services:
Estate planning for blended families
Top Questions Clients Ask About Medicaid Planning in Florida
Schedule a Consultation for Medicaid Planning Assistance
At Selis Law Firm, we are proud to be the trusted advisor for our clients’ elder law needs. We help our clients, along with their families, navigate tricky and complex situations as they age, including preparing for and paying for long-term care, negotiating Medicaid and Veterans benefits, and handling estate planning and probate needs. If you need professional, compassionate Medicaid planning assistance in Daytona Beach, Ormond Beach, FL, Palm Coast, FL, or elsewhere in Florida, our attorneys can help. Call us now or contact us online to schedule a consultation with one of our Medicaid attorneys.
Your Local Attorney for Elder Law