Filing for Florida's Medicaid Long Term Care Program

The Florida Medicaid Long Term Care Program is a crucial resource for individuals who need extensive healthcare services due to age, illness, or disability. Understanding the filing process is essential to gain access to necessary long-term care assistance. This guide will help you navigate filing a Medicaid application, highlight key steps, and clarify critical considerations.

Understanding the FLorida's Medicaid Long Term Care Program

Medicaid is a joint federal and state program that helps cover medical costs for eligible individuals. The Florida Medicaid Long Term Care Program specifically supports those requiring long-term institutional or home-based care. Many individuals face long-term care costs that average $10 to $11,000 per month for nursing homes. Qualifying for Medicaid can significantly ease the financial burden. The Medicaid program in FL is administered through the Department of Children and Families (DCF).

Eligibility Requirements

Before applying, it is vital to ascertain whether you meet the eligibility criteria for Florida's Medicaid Long Term Care Program. Generally, eligibility hinges on three main factors:

• Age or Disability: You must be 65 years or older, or fulfill Social Security Administration disability standards.

  
  

• Income Limits: Florida uses the Modified Adjusted Gross Income (MAGI) method for assessing income. As of 2025, individual applicants must have a total monthly gross income of less than $2901 to qualify. (It is still possible to get around this with a tool called a Qualified Income Trust. This tool needs to be drafted by an attorney well versed in FL Medicaid program law, and has to be precisely implemented each and every calendar month).

  
  

• Asset Criteria: Your countable assets should not exceed $2,000 for individuals (higher limits may apply for couples who are both applying for the same benefit). This includes bank accounts, stocks, life insurance with cash value and properties (including any property titled to the applicant) but typically excludes your homestead valued up to $730,000. Extensive and precise documentation is required to prove eligibility. The community dwelling spouse (not applying for Medicaid) has an asset limit of $157,920.00

  
  

• Level of care: The applicant has to have the medical need for the services provided. This involves a form completed by the applicant's physician and reviewed by the CARES assessment team assigned to the case.

  
  

Gathering Necessary Documentation

Completing a Medicaid application requires careful preparation of specific documents. Ensure you have the following ready:

1. Identification: Government-issued ID (Drivers License, passport or VA ID), Proof of Citizenship, and Social Security number are essential.

   
   

2. Financial Statements: Collect 3 most recent bank statements for all accounts named with the applicant and / or applicant spouse, and proof of gross income and any deductions from all sources to clearly document your financial situation. Medicaid will also want proof of any assets that have been closed within the 60 mos period and proof of where the funds went.

   
   

3. Medical Records: Provide a summary of your medical history and current healthcare needs from your physician. This documentation is crucial in justifying your application. A medicaid 3008 form must be completed by the MD

   
   

4. Housing Information: Include any details regarding your residence, and if applicable, information on additional properties ( lots, land, vacation home, timeshares, and properties that may be jointly title with other persons).

   
   

All materials should be accurate and up to date to support your eligibility claim effectively. Be advised that Medicaid has a 60 mos lookback. There are penalties for assets transferred out of the applicants name within that time frame with the exception for interspousal transfers. All assets open, closed, sold or transferred within the 60 mos lookback must be accounted for.

The Application Process

The application process for the Florida Medicaid Long Term Care Program can be very confusing The problem is that we don't spend our lives planning to apply for this benefit so things don't always add up perfectly to meet the elibiility criteria. It is difficult to know how to make adjustments prior to application without professional help. Even when the documentation is gathered, the actual filing process is still long and arduous - even for professionals who do this daily.

1. Online Application: You are encouraged to submit your application through the www.myflfamilies.com website. Although the process has improved, it is still very confusing and requires a computer and knowledge / ability to upload documents. There are many application types and subtypes, and it is crucial to specify which application you are applying for. Some programs have a waitlist and will not allow you to apply until your turn comes up on the waitlist

   
   

2. Fax or Mail: you can submit a written application with copies of supporting evidence to the Access center (which is essentially a scanning center). This can really slow up an application and is not recommended. You can never be sure that the documents scanned properly or that all documents submitted actually go scanned.

   
   

Awaiting a Decision

After submitting your application, the DCF will review your filing. This typically takes about 30 days, depending on the volume of applications. During this time, they will verify your information.

If the DCF needs more information, they will reach out to you via mail or phone. Staying vigilant and responsive can expedite your review. You must ensure that all requested documentation is submitted promptly within the deadline stated on the request. You do have up to 60 days from the date of application received before the case will be closed for noncompliance with requests or inability to prove eligibility.

Understanding the Decision

Once your application has been thoroughly reviewed, you will receive a notice detailing your qualification status. If denied, the notice will explain the reasons. You have the right to appeal the decision if you believe an error occurred.

Filing an appeal involves following specific steps outlined in the notice, and understanding the timeline is crucial to ensuring your situation is re-evaluated. A fair hearing involves a telephonic appearance before a judge to determine if the eligibility evidence was submitted timely and proves eligibility for the applicant.

What to Do if Approved

If you receive approval for Medicaid Long Term Care, that’s a significant milestone. Here are steps to follow next:

• Choosing a Provider: It is essential to select a Medicaid-approved care provider. Investigate your options, read reviews, and visit facilities to find one that best meets your needs.

  
  

• Coordinating Services: Your chosen provider will coordinate care services with Medicaid. It is important to clarify what services are covered and what co-payments may be required.

  
  

• Regular Check-Ins: Ongoing communication with your healthcare provider ensures that your care needs are met consistently. Make it a habit to discuss any changes in your condition.

  
  

• Report changes in status: Recipients are required to report any changes in medical, financial, or living arrangements within 10 days of the change.

  
  

• Annual recertifications: Every year, Medicaid recipients have to recertify benefits with evidence that they continue to qualify for benefits. Medicaid will review statements from the prior year to ensure there were no major changes in status.

Common Issues and Challenges

Filing for Florida Medicaid Long Term Care can be daunting. Many applicants encounter challenges including:

• Document Preparation: Gathering required documents can be confusing, as the list may vary. Applicants often find it difficult to understand what proof is necessary or just exactly what DCF is asking for

  
  

• Income and Asset Calculations: Applicants sometimes miscalculate their income and assets, leading to errors in their applications.

  
  

• Navigating Appeals: Handling an appeal after a denial can be overwhelming. Many do not know the right steps or timelines involved.

  
  

Seeking help from community resources or legal advisors can ease these challenges and improve your chances of success. This is a very complex system with ever changing rules and eligibility requirements. It is highly recommended that you work with a Medicaid Filing professional such as an elder law attorney or someone with extensive experience in the qualifying and filing of these benefits. Elder Advocates Inc. would be happy to help you with Medicaid application filing.

Moving Forward with Confidence

Understanding the complexities of filing for Florida's Medicaid Long Term Care Program is overwhelming. By working with a professional who knows the "ropes" you can navigate your journey with confidence.

Elder Advocates Inc can handhold you through the Medicaid application filing process

NOTE: This publication reflects the professional experience and opinions of Patrice Antony, PT with 44 years of experience. AI tools were used soley to assist with formatting and enhancing readability. All content was written, reviewed and edited by the author, who takes full responsibility for its accuracy and integrity.

Patrice Antony, PT, Care Manager,

Elder Advocates Inc.

For more information on Medicaid filing assistance call (407) 951-5266.