Short-Term Skilled Nursing & Rehabilitation 

A stay in a skilled nursing facility is different from long-term custodial nursing-home care. Skilled nursing care is generally intended for someone who needs short-term nursing or rehabilitation services following an illness, injury or hospitalization. 

What Does Medicare Cover?

Original Medicare Part A may cover care in a Medicare-certified skilled nursing facility when certain requirements are met. Generally, the individual must need daily skilled nursing or therapy services and have a qualifying inpatient hospital stay of at least three consecutive days. The day of discharge does not count toward the three-day requirement. In most cases, admission to the skilled nursing facility must occur within 30 days of leaving the hospital. Medicare

One important distinction is inpatient versus observation status. Time spent in the hospital under observation is generally considered outpatient care and does not count toward the traditional three-day inpatient requirement. Some Medicare Advantage plans and certain Medicare programs may waive the three-day requirement. Medicare

When the requirements are met, Original Medicare can provide up to 100 days of skilled nursing facility coverage during a benefit period. Coverage is not intended to provide permanent nursing-home or custodial care. Medicare

Medicare generally does not pay for long-term custodial care when that is the only type of care a person needs. Custodial care includes assistance with everyday activities such as bathing, dressing and using the bathroom. Medicare

Medicare Advantage plans may have different costs, network requirements and coverage rules, so seniors should check directly with their individual plan before making care decisions.

Florida Medicaid & Long-Term Care

Medicaid is different from Medicare. Medicaid is a needs-based program, and eligibility for long-term care services can depend on a person's income, assets, medical needs and other circumstances.

In Florida, the Institutional Care Program (ICP) can help eligible individuals pay for nursing-facility care and other medical services. An individual must meet financial requirements as well as the required level of care. Florida also has Medicaid long-term-care services that may allow eligible individuals to receive assistance in other settings. DCF Florida

Eligibility rules can be especially important when a married person needs long-term care while their spouse continues living in the community. Special rules may allow a community spouse to retain certain income and assets. FFC

Florida Medicaid also reviews certain transfers of assets made before an application for long-term-care benefits. For applicable long-term-care programs, Florida currently reviews transfers made during the 60 months before the application month, commonly referred to as the five-year look-back period. DCF Florida

Because Medicaid financial limits and allowances can change and individual circumstances vary, seniors and their families should obtain current eligibility information before transferring property, gifting assets, changing ownership of a home or making other significant financial decisions.

Important: Medicaid planning can involve legal, financial, tax and estate-planning considerations. I do not provide legal or Medicaid-planning advice, but I can help identify questions to consider and connect you with an appropriate elder-law attorney or other qualified professional.

Florida Medicaid Resource:
Florida Department of Children and Families — MyACCESS

Home Ownership, Reverse Mortgages & Medicaid 

Your Home, Home Equity & Medicaid Planning

A home can receive special treatment under Medicaid eligibility rules, but that does not mean the home should automatically be considered completely protected or ignored when planning for long-term care.

Depending on the circumstances, factors such as the amount of home equity, whether a spouse or certain other family members continue to live in the home, the individual's intent to return home and the type of Medicaid benefits being received may affect how the property is treated.

A reverse mortgage can add another consideration. Reverse-mortgage loan proceeds generally are not treated the same as earned income simply because they are received. However, money that remains unspent and is held in an account may become a countable asset for certain needs-based benefit programs. For someone receiving or applying for Medicaid or another needs-based benefit, the timing and handling of loan proceeds can therefore be important.

Similarly, using assets to pay a mortgage, make home improvements, purchase another home, transfer property or change the way a property is titled can have consequences that should be evaluated before the transaction occurs.

Before using home equity, transferring property or making significant financial changes when Medicaid eligibility is a concern, consult a qualified Florida elder-law attorney or Medicaid-planning professional.

Medicaid Estate Recovery 

Medicaid estate recovery is an important consideration for seniors and families who own a home or other property.

Federal law requires states to seek recovery of certain Medicaid benefits paid on behalf of some recipients. In Florida, after a Medicaid recipient dies, the state may seek repayment from the recipient's estate for certain Medicaid benefits that were provided.

This does not mean that family members automatically become personally responsible for repaying the Medicaid benefits. Instead, recovery may involve assets that are part of the deceased recipient's estate.

There are important exceptions, protections and circumstances that can affect estate recovery. For example, the existence of a surviving spouse, certain children or other qualifying circumstances may affect whether or when recovery can occur. Hardship provisions may also be available in some situations.

Because ownership of the home, probate, trusts, deeds and other estate-planning decisions can affect what happens after death, it is important to understand the potential consequences before changing ownership or transferring property.

If Medicaid benefits, a home and estate planning are all involved, a Florida elder-law attorney should be consulted before making significant decisions.