Nursing home care in a skilled nursing home in Northeast Florida now averages about $85,000 per year. If you, or a family member or other loved one, needs skilled nursing home care, there are only three ways to pay for the cost of the nursing home care. The first is to use your own assets to pay for nursing home care, assuming you have sufficient assets. The second is to use long term care insurance, which is becoming increasingly difficult, and expensive, to obtain, as more insurance companies eliminate long term care insurance from their offerings.

The third option for paying the cost of nursing home care is through Medicaid benefits, specifically the Institutional Care Program (“ICP”) offered through Medicaid. A Medicaid spend down plan, put together by a qualified and experienced elder law attorney or Medicaid planning lawyer, can allow you to preserve signficiant assets for your family and the nursing home resident, while qualifying for Medicaid benefits to pay for nursing home costs.

Eligibility for Medicaid benefits through ICP is based on three eligibility criteria. To qualify for the Medicaid benefits through ICP, the skilled nursing home resident must meet all three sets of eligibility to receive Medicaid benfits to pay for nursing home care. The three sets of criteria include (1) medical need, (2) the income test, and (3) the asset test.

To qualify as having a medical need for nursing home care the applicant for Medicaid benefits must establish, through medical examination, that he or she is unable to perform at least 3 of the activities of daily living (“ADLs”) without assistance from someone other than the applicant. The ADLs include: (1) the ability to dress oneself without assistance, (2) the ability to bathe without assistance, (3) the ability to feed oneself without assistance, (4) the ability to toilet without assistance, (5) the ability to get into or out of bed/chair/toilet without assistance (called “functional transfers”), and (6) the ability to move from room to room or into and out of the house without an assistive device (walker, cane, wheelchair).

The seond test is the income test. Under Florida’s administration of the ICP, the limit for income allowed to qualify for Medicaid benefits for 2012 is $2,094 per month. If the nursing home resident’s income is greater than $2,094 per month it is necessary for the resident to establish a Qualified Income Trust to qualify for Medicaid benefits to pay for nursing home costs. A qualified income trust (“QIT”) is an irrevocable trust (sometimes called a “Miller Trust”) that is designed to ensure that any income of the resident over the level allowed by the Medicaid law, will be available for Medicaid recovery by the state at the resident’s death.

The third test that must be met is the resource, or asset, test. The resident may have only two thousand dollars ($2,000) of countable assets to qualify for Medicaid nursing home benefits. If there is a spouse who remains in the home (called the “community spouse”), he or she will be allowed to retain a maximum of $113,640 of countable assets without affecting the other spouse’s eligibility for Medicaid benefits to pay for nursing home costs.

With proper Medicaid spend down planning by an experienced elder law attorney or Medicaid planning lawyer, there is a significant amount of assets above the allowable level that can be preserved for the family through the restructuring of assets from “countable” to “non-countable,” and through the spend down of assets in a legally correct manner, so that substantial assets can be preserved for the family, and for the nursing home resident, and still allow the nursing home resident to qualify for Medicaid benefits to pay for nursing home costs.

If you would like us to evaluate how much of your family assets can be preserved while still qualifying for Medicaid benefits to pay for nursing home costs, please call our office at 904-448-1969, or email us at, to schedule an appointment to meet with our Medicaid planning lawyer and elder law attorney.

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