Medicaid and Senior Living Florida: Everything You Need to Know

Many Americans are unaware of the options for the care of an aging loved one. As a result, there is a growing problem with the country’s elderly being homeless. By 2030, over 106, 000 seniors will be homeless, up from 40,000 today.

However, it is possible to prevent elderly family members from becoming homeless. Florida offers a wide variety of care facilities, hospices, and community services for the elderly.

The key is knowing what is available and how to navigate the system. Medicaid coverage for senior living Florida is not as simple as you may think. Medicaid’s eligibility requirements are constantly changing.

This guide will help you understand how Florida Medicaid works and when it covers senior living.

What Is Medicaid?

It is a government-run health insurance program covering 43.7% of Americans living below the poverty line. The program helps them pay for medical care to ensure they stay healthy and receive the assistance they need.

A majority of Medicaid recipients cannot afford other health insurance. It covers various health services while keeping out-of-pocket expenses to a minimum.

In 1965, the Medicaid program was signed into law to help the growing population who could not afford health insurance. Each state and U.S. territory has its own Medicaid program, which is run according to the government’s guidelines.

Medicaid coverage differs from state to state due to how each state administers its program. This makes it even more essential for you to learn how senior living in Florida works.

Is Medicaid the Same as Medicare?

No, there are key differences between the two. Medicaid and Medicare are two different government programs with separate guidelines.

Medicaid is specifically for those with a very love income who can not afford medical costs independently. Usually, people will pay little to none for their health care costs when they have Medicaid.

Medicare provides health coverage for those 65 and older despite their income level. A person can be eligible for both programs depending on their situation.

Since trust funds pay medical bills for those who have put money into the program before the age of 65, Medicare can be viewed as an insurance program. A small deductible covers medical costs, and a monthly premium is charged for coverage outside of hospitals.

How do you become eligible for Medicaid?

For someone to become eligible for Medicaid, their income must be below the poverty line. Some groups of the population are considered mandatory for approval, which includes:

  • Pregnant women
  • Low-income families
  • Children living 133% below the poverty line
  • Those receiving SSI benefits
  • Seniors 65 and older living under the poverty line

As a result of the Affordable Care Act, a new method to calculate income eligibility has been created: Modified Adjusted Gross Income (MAGI).

This method determines the financial eligibility for the Medicaid and CHIP programs. MAGI also determines the tax credits and reductions in the health insurance market.

Following this one method allows people to become eligible for Medicaid easier. Also, more people can now receive health insurance.

Medicaid eligibility now takes into account taxable income and filing relationships. Contrary to the methods of the program that ended in 1996, the MAGI methodology does not disregard income that varies by state, eligibility group, or property.

How Does Medicaid Work for Senior Living Communities in Florida?

In Florida, those who are eligible can receive an Assisted Living for the Elderly (ALE) Waiver. It is provided for those who need assistance with daily activities and care in a senior living community.

As nursing homes can be a bit more costly than assisted living communities, the waiver allows the elderly to avoid homelessness and receive the proper care.

Below are the three factors to be eligible for an ALE Waiver:

  • Age
  • Functioning abilities
  • Having low income

The waiver is not available to individuals under 60 years of age, regardless of their functional abilities. If a senior is 60 to 64 and is considered by Social Security to be disabled, they may be eligible for SSI.

Those 65 and older can receive a waiver if they need assistance with four or most daily activities. These activities include bathing, using the toilet, and grooming.

Alzheimer’s patients and those with other progressive conditions qualify, even if they do not require that level of assistance.

When it comes to income, the state of Flordia will consider both the applicant’s and spouse’s incomes and assets. If the monthly income exceeds more than $2,163 individually or $4,326 married, the applicant will not qualify for the waiver.

Although if just one spouse applies for Medicaid, the applicant may be able to qualify with adjustments.

What About the Florida Medicaid Program for Long Term Care?

Florida started the Medicaid Managed Care Long-Term Care Program in 2013 to further assist the elderly population. Seniors who receive Medicaid can receive long-term care within their home, nursing faculty, or an assisted living faculty.

Like a health insurance plan, the program focuses on long-term care services only. None of the expenses can be used to cover medical costs.

For those who qualify, seniors will select a plan from the provider who offers the services within their area. Florida divides this program into 11 regions in the state.

Also, there aren’t providers in every area, so one may have to travel to the provider’s location. The provider will become responsible for all of the senior’s long term needs.

If you’re struggling to find one, a counselor can assist you in finding a provider near your area. For eligibility for the program, you must be 65 and older and need the level of nursing faculty care.

How Can Medicaid Help Cover the Costs of Senior Living in Florida?

Medicaid for senior living communities does come with limitations. For example, the program does not pay for the total cost of an assisted living facility, and it does not pay for 24/7 in-home care.

In Florida, Medicaid offers help by reducing senior living costs and will cover between $1,100 and $1,500 a month. The program also does not pay for the room and board in senior living homes in Florida. The assisted funds are more to help cover the cost of medical care.

When searching for a senior living home, it’s essential to learn how Medicaid covers costs within the faculty. Not every facility applies the Medicaid subsidy the same way as another facility.

During the initial interview for seniors living in the facility, we’ll discuss how Medicaid covers the cost without faculty. We will also find other ways to cover expenses that Medicaid does not.

What Does Medicaid Cover and What It Doesn’t Cover?

When it comes to seniors living in Flordia, Medicaid will not cover every cost for the elderly. The main focus is to cover healthcare costs such as medication, case management, and personal care.

While living in a senior living community, Medicaid covers personal care, and three meals are provided daily to the elderly. In case of an emergency such as a fall, Medicaid will cover medical assistance costs.

Medicaid does not cover the cost of the room, amenities, furniture, clothing, or extra fees senior living homes may have. Case management services seniors find other ways to afford assisted living if they are on Medicaid.

What Are the Benefits of Medicaid for Senior Living in Florida?

The Medicaid program provides a way for families to provide proper care for their elder loved ones. As healthcare cost continues to rise, many seniors struggle to afford their medication and additional assistance.

In caring for the elderly, prescription drugs account for a significant portion of the cost. Recent data reports, that the average amount spent on prescription medications by those 65 and older is over three percent of their income.

The rate increases even more if you include over-the-counter medicines. Many adults choose not to take their medication to avoid buying the high cost risking them becoming sicker.

Medicaid allows this not to happen and ensures seniors can afford their medicine to stay healthy. In addition, there are benefits for the elderly living in senior living communities.

Aside from receiving the necessary care, they also have an opportunity to connect with those their own age. Assistive living communities offer an array of amenities and activities designed to help the elderly stay active and engaged.

Are There Any Drawbacks of Medicaid for Affordable Senior Living in Florida?

The drawback of the Medicaid program is that everyone may not be eligible for assistance, even if they have a low income. The income level has to be 133% below the poverty line. If you’re above it, then your application may be denied.

Another drawback of the program is Medicaid does not cover everything for the senior living communities in Flordia. The room and amenities can be difficult to pay for when you’re still within the poverty range of income.

If you find yourself in this situation, know there are other ways to pay for assisted living. For example, veteran benefits may help cover some of the costs of the assisted living room. Life insurance is another way many people use to cover the expenses that Medicaid does not.

It is possible for some seniors to remain in assisted living by relying on an annuity. Annuities are contracts between people and insurance companies to help them meet long-term financial goals, including retirement.

Various types of annuities exist, each with its own benefits and drawbacks. An insurer may agree to provide periodic payments to you in return for a lump-sum payment or series of payments you make.

There is no set beginning date for disbursements. It can start immediately after you receive it or a couple of months later.

Annuities are not for everyone, and some may not like the idea of having to use one for a faculty. But, it is another way retired people can use their savings to create a way to pay for residential and long-term care.

What Are the Average Costs of Senior Living Homes in Florida?

According to Genworth’s 2019 Cost of Care Survey, Florida’s average cost of assisted living is $3,500 per month. While prices vary greatly across the state, the average low is $2,836 per month, and the average high is $5,375 per month.

Miami, Tampa, Punta Gorda, and Sebastian are some of the state’s most affordable areas for assisted living. Approximately $2,836 – $3,375 is the monthly average cost in these regions.

Gainesville, Lakeland, and Port St. Lucie offer fairly reasonable living conditions with an average monthly cost consistent with the state average. Typically, these areas are between $3,463 and $3,500 in price.

Assisted living is most expensive around Panama City, Deltona, and Tallahassee. Prices are between $4,500 and $5,375 per month.

For seniors with Alzheimer’s and other severe conditions, the cost of assistance is often more. It is usually about 20%-30% more expensive for Alzheimer’s patients to reside in an assisted living facility.

The cost of Alzheimer’s and memory care in Florida assisted living communities generally ranges from $709 to $1,343 per month. This is because these types of care provide a higher level of supervision and security.

Ready to Learn More About Senior Living Florida With Heidi’s Haven

During the retirement stage of one’s life, one should not have to worry about the risk of homelessness or how to pay for healthcare. Senior living communities in Flordia offer a way for the elderly to live peacefully and safely in a comfortable environment.

Also, Medicaid is a way for low-income elders to pay for their medications and healthcare cost.

Heidi’s Haven is a senior living in Flordia that accepts Medicaid and works with its residents to find ways to cover other expenses. To learn more about senior living Flordia, contact us for our services.

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