Florida Medicare

Medicare is an entitlement-based Federal program that provides Medical insurance for the aged or disabled. While Medicare pays for expenses incurred in hospital stays, it can also assist with payments for up to 100 days in the nursing home if the individual meets certain requirements. Medicare pays the entire cost for the first 20 days but the individual is required to pay a co-payment for the remaining 80 days. Many people have Supplemental Health Insurance policies that cover this co-payment, which goes into effect after the 20th day. It is important to note Medicare coverage does not necessarily remain in effect for the entire 80-day period after the first 20 days. Medicare may stop paying at any time depending on the individual’s medical condition. Since Medicare pays for a relatively short period of time, only about 2 percent of nursing home expenses in the United States are covered by Medicare.

Medicaid Institutionalized Care Program (ICP)

Medicaid was originally designed to provide low-income persons with financial assistance to meet the costs of medical care and housing. Medicaid provides a variety of medically related assistance at reduced or no cost to those who qualify. There are many benefit programs that fall under the Medicaid umbrella, and each one has its own set of requirements for qualification of benefits. This website provides information dealing with the Institutional Care Program (ICP), commonly referred to as the Nursing Home Care Program.

Medicaid ICP is a government assistance program based on financial need. It provides qualified people with financial assistance to pay the cost for nursing home care. ICP is jointly funded by federal and state government and is administered by the Department of Children and Families (DCAF) in Florida. Medicaid does not pay the entire cost of a person’s nursing home expenses. The person must contribute an amount based on his/her monthly income (Patient Responsibility) and Medicaid pays the nursing home the approved rate for the facility.

For a single person living in Florida, Patient Responsibility is the person’s total gross income minus $35 for personal expenses. For a married couple, calculating Patient Responsibility is a bit more complicated. Generally, if the well-spouse (community spouse) has a modest income, he/she is allowed to receive a portion of their spouse’s income to help maintain a reasonable standard of living.

There are two major tests an applicant must pass in order to become eligible for Medicaid. The first test is the “Asset Test”. A person cannot have too many assets in order to qualify. The second test is the “Income Test”; similarly, the applicant cannot have too much income in order to qualify. The Medicaid applicant must meet both financial tests in order to qualify for Medicaid benefits.