Not only does our community provide our residents with all-inclusive care and services, but the care portion of those services may also be funded by the Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) program for eligible, qualified, and active Florida Medicaid beneficiaries. Utilizing Medicaid dollars makes all the difference for many of our residents, but accessing the program can seem a bit daunting. 

“Finances – ‘how am I going to be able to pay for this?’ – that’s always our residents’ first concern,” said Placement Specialist Sarah Ingram, of Best Life for Seniors.

Our goal is to provide you with a framework and the tools to help you navigate the financial aspect of your journey. And for many, the answer to “How can I afford this?” comes through the help of the Medicaid SMMC-LTC program.

Medicaid SMMC-LTC is a health assistance program for Florida Medicaid beneficiaries who, because of a physical or developmental disability, cognitive impairment, or other chronic health condition, are unable to accomplish tasks that they would ordinarily do for themselves if they were not disabled. In Florida, the recipient must be determined to meet a medical “level of care” requirement. Medicaid reimburses for over two dozen home and community-based services, including assisted living services, through this program.

In order to qualify for the Medicaid SMMC-LTC program, an individual must first qualify for Florida Medicaid. 

Florida Medicaid is available to individuals who are:

• Age 65 or older,
• Blind,
• Disabled or who have a family member in their household with a disability,
• Pregnant, or
• Responsible for a child 18 years of age or younger.

In addition, to be eligible for Florida Medicaid, an individual must also be: 

• A resident of the state of Florida, 
• A U.S. national, citizen, permanent resident, or legal alien, 
• In need of health care/insurance assistance, and 
• In a financial situation that would be characterized as low income or very low income. 

A major requirement for Medicaid eligibility is demonstrated financial need. Florida Medicaid has an income limit of $2,742 per month for those seeking assisted living care. In addition, an individual may not have more than $2,000 in resources. Resources include cash, bank accounts, retirement accounts, stocks and bonds, cash value of life insurance policies, and other investments. 

For those who are living solely on Social Security, those numbers are usually manageable. However, people who have additional income from pensions and other sources may find that these income sources quickly push their monthly income totals above the limits.

Pre-planning is vitally important, because all assets must be out of the resident’s name five years before the resident becomes eligible for Medicaid. It’s important to be prepared because medical emergencies cannot be predicted. Everything—from vehicles to homes and real estate—must be divested five years before you become eligible for Medicaid.

For many, a spend down—the process of reducing your income and assets in order to be eligible for Medicaid—is a valuable tool. However, there are requirements placed on the spend-down process. Money spent on the senior’s care, whether it’s a burial plot or paying for medical care, is an example of an acceptable choice when spending down assets.

Another way to manage the costs of care is to consider the varied living options and price points for assisted living or memory care services. Whether it’s a deluxe single suite, a studio-style apartment, or the companionship that comes from sharing a semi-private room with a roommate, there is an option to fit every need — and every budget.

When you apply for Medicaid, the state of Florida will initiate what’s called a 60-month Medicaid Look-Back Period. This means that the state will examine all your asset transfers over the past five years to ensure that no assets were sold for less than fair market value or given away. This look-back review includes examining asset transfers made by one’s spouse. If the state determines that the look-back rule has been violated, the state assumes that the violation was committed to meet Medicaid’s asset limit. The state will then calculate and impose a penalty period of Medicaid ineligibility.

An online spend down calculator can help you determine exactly how much of your assets must be spent down in order for you to be eligible for Medicaid long-term care. A spend down calculator is available here: medicaidplanningassistance.org/medicaid-spend-down-calculator.

INFORMATIONAL PURPOSES ONLY: The materials and information on this website have been prepared or assembled by the Community and are intended for informational purposes only. The information is general in nature and is not intended to be, and should not be relied upon as, legal advice. Some of the information may be out-of-date and may not reflect the most current legal developments regarding Medicaid eligibility. This website contains information on legal issues and is not a substitute for legal advice from a qualified attorney licensed in the appropriate jurisdiction. Establishing Medicaid eligibility can be a complicated process, and the Community urges you to consult an attorney or specialist in Florida elder law to help you navigate these issues. The Community expressly disclaims all liability with respect to actions taken or not taken based on information contained or missing from this website.