10 FAQ’ s About Medicaid for Long-Term Care
by Jessica Close, Esq. Close Law
1. Does Medicare pay for long-term care, and if so, why do I need Medicaid?
Medicare does not pay for long-term care. Medicare will pay 100 % of a patient’ s first 20 days in a rehab facility after a qualifying hospital event. The patient can stay in rehab for up to 100 days, with increasing co-pays due for days 21-100. However, the patient’ s rehab can be cut off prior to the 100-day limit if they are no longer making progress on their rehab. Once Medicare has cut off rehab, the patient can return home if they are healthy enough; if not, they can stay in skilled nursing longterm care, but they must private pay( which costs about $ 10,500 per month) or apply for Medicaid to assist with the cost.
2. Will Medicaid pay 100 % of my bill owed to the skilled nursing facility?
Medicaid does not usually pay for 100 % of the skilled nursing facility bill. Once approved, the Medicaid recipient owes a“ patient responsibility” to the nursing home. This functions somewhat like a copay. The individual pays their patient responsibility to the facility, and Medicaid pays the remainder of the bill. The patient responsibility is roughly equal to the recipient’ s gross monthly income minus a $ 160 personal needs allowance, any spousal diversion of income, and / or any medical expenses( like the cost of a Medicare supplemental insurance).
3. How can I qualify for Medicaid if my income is too high?
The current income limit for an individual to qualify for Medicaid is $ 2,901 in gross monthly income. If an applicant is one penny over that limit, they do not qualify for Medicaid unless a Qualified Income Trust( QIT) is established. QITs are somewhat complicated to establish and manage each month, so this is often an area that causes problems for Medicaid applicants. However, too much income is rarely a problem for Medicaid qualification if the QIT is properly set up and funded.
4. How can I qualify for Medicaid if my assets are too high?
The current asset limit for individual Medicaid qualification is $ 2,000 in“ countable assets.” Not all assets count towards Medicaid qualification. Examples of common exempt assets are the primary residence( equity limits may apply), one vehicle, and retirement accounts( if distributions are taken at least annually). Examples of common countable assets include bank accounts, investments that are not retirement accounts, life insurance with a cash value, and real estate other than the primary residence. When an individual is over the asset limit, their choices are to either spend down the excess assets or to convert countable assets into exempt assets.
5. Do I need a Medicaid Divorce?
There are not many scenarios in which a Medicaid divorce makes sense in Florida. Medicaid allows community spouses( those not needing Medicaid) to keep up to $ 157,920( as of 2025) in countable assets while the institutionalized spouse( needing Medicaid) can still qualify. If the couple’ s assets are over that limit, spousal refusal may be an option. Also, if the community spouse’ s income is low enough, Medicaid may allow all or a portion of the institutionalized spouse’ s income to stay with the community spouse. The community spouse can also get a court order of support through a family law proceeding to get the institutionalized spouse’ s income.
6. Do I need a Medicaid Trust?
It depends. Medicaid Asset Protection Trusts are sometimes used as a pre-planning tool. These trusts must be established at least 5 years before applying for Medicaid, otherwise money transferred to the trust is counted as an uncompensated transfer and a penalty period in which the applicant cannot qualify for Medicaid is imposed. The Medicaid applicant cannot be the Trustee, and no principal can be distributed to the applicant. This loss of control and use of the assets in the Trust can be a sticking point for those considering Medicaid planning.
7. Do I need to spend down my assets 5 years before applying for Medicaid?
Not necessarily. Much of what elder law attorneys do is called“ crisis planning.” This means that the client is in a facility now and needs to qualify for Medicaid right away. A Medicaid Asset Protection Trust will not help at this point( unless it was already established and funded 5 years ago). Instead, elder law attorneys help clients qualify using tools like personal services contracts, pooled trusts, or income-producing properties.
8. Can’ t I just give my excess assets to my children before I need Medicaid?
No. The Department of Children and Families reviews an applicant’ s finances for the past 5 years to see if any assets have been given away. Any transfers for less than fair market value in return will be presumed to be a disqualifying gift. This presumption can be rebutted, but it is not guaranteed. For example, if the applicant gave a grandchild money to pay for their college education four years ago, there is a good chance that
26 | THE DOCKET- SEPTEMBER 2025