Importance of Careful Long Term Care Planning

The Florida Second District Court of Appeal, this past November (2015), ruled that the court appointed guardian of a Medicaid beneficiary receiving nursing home benefits may not deduct a guardianship fee from the Medicaid recipient’s income because the guardian’s fee is not medically necessary. Lutheran Services Florida, Inc. v. Department of Children and Families (Fl. Ct. App., 2ndDist., No. 2D13-5840, Nov. 25, 2015). This case makes it clear, at least until the Florida legislature may change the applicable law, that careful long term care planning must be completed in a Florida guardianship if the guardian is to be compensated when the ward qualifies for Medicaid benefits to pay for nursing home costs.

Lutheran Services Florida (LSF) was the court-appointed guardian of nursing home resident Larry Peron. LSF’s duties included reviewing Mr. Peron’s medical treatment and giving legal consent for medical procedures. When Mr. Peron qualified for Medicaid, he paid the majority of his income to the nursing home as the patient responsibility amount.

LSF obtained a court order authorizing that a monthly $200 guardianship fee be deducted from the Medicaid beneficiary’s income and petitioned the Department of Children and Families to deduct the Medicaid beneficiary guardianship fee from Mr. Peron’s patient responsibility amount. The Department denied the petition, determining that the fee cannot be deducted from a Medicaid recipient’s income because it is not “medically necessary” under state law. A hearing officer upheld the determination, noting that state law defines medically necessary as services provided in accordance with generally accepted standards of medical practice and reviewed by a physician. LSF appealed.

Florida Court of Appeals Affirms Hearing Officer

The Florida Court of Appeals affirmed the hearing officer, holding that the guardianship fee is not medically necessary. According to the court, state law allows only deductions from a Medicaid beneficiary’s income for “medical or remedial care services rendered by a medical professional directly to the Medicaid recipient.” The court acknowledged that the result leaves a gap “wherein a guardian of an incapacitated ward who provides the necessary consent for medically necessary treatment cannot be compensated for its services under the state’s Medicaid program,” and suggests that the legislature look into changing the law.

This case is a reminder of how important it is to consult with a qualified Medicaid planning elder law attorney when planning for long term care during a guardianship in Florida, especially if there is a Medicaid beneficiary guardianship fee involved. The Coleman Law Firm is a Elder Law Firm with extensive experience in Medicaid Planning and Planning for Long Term Care. Please call us at (904) 448-1969 or ask a question through our Request Information form to learn more about Elder Law, Medicaid, and planning for Long Term Care.

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