Disability Assistance in Florida, Part 2

Let’s face it. There is no easy way to quickly understand all you would need to know about the many avenues and requirements for disability assistance. That’s why we elder care attorneys hone our own understanding to help guide you.

In Part II of this primer on sources of disability assistance in the State of Florida, we’ll learn about the CARES process and how it can open the door to specific financial support programs managed by the State of Florida.

Comprehensive Assessment and Review for Long-Term Care Services (CARES)

Comprehensive Assessment and Review for Long-Term Care Services (CARES) is Florida’s pre-admission screening program for applicants seeking financial assistance for skilled nursing and assisted living or home care. Federal law mandates that the CARES Program perform an assessment or review of each individual who requests Medicaid reimbursement for nursing facility placement, or who seeks to receive home and community-based services through Medicaid waivers like the Project AIDS Care (PAC) waiver and the Statewide Medicaid Managed Care Long-Term Care (SMMCLTC) Program.

A CARES assessment is also mandatory if a private-pay applicant is suspected of having an intellectual disability or mental illness. Any person or family member can initiate a CARES assessment by applying for the Medicaid Institutional Care Program (ICP).

A physician or registered nurse reviews the assessment and application to determine the level of care that is most appropriate for the applicant. The assessment identifies long-term care needs, establishes the appropriate level of care (medical eligibility for nursing facility care), and recommends the least restrictive, most appropriate placement.

An assessment determines medical eligibility:

• Medical eligibility for the Medicaid Institutional Care Program (ICP)
• Medical eligibility for Medicaid waivers that provide community-based services
• Medical assessment for all mentally ill individuals requesting ICP
• Medical assessment for individuals with intellectual disabilities requesting ICP services

There are several popular programs managed by the State of Florida, and all have specific rules and restrictions for financial eligibility as well:

• The monthly income cap for Florida is currently $2199.
• Other income restrictions exist for specific programs.
• There are asset limits for the applicant and his or her spouse.

We’ll review several programs below. This information is by no means comprehensive and we highly recommend that you seek the advice of an elder law attorney or other appropriate professional.

Institutional Care Program (ICP Medicaid)

ICP Medicaid is the only program that I am aware of that does not have a waiting list. At least, that has been the case for some period at the time I’m writing this post.

Specifically, ICP Medicaid helps pay room and board and cost of care at a skilled nursing facility. Here are some rules to keep in mind.

1. The patient must pay all gross income beyond unreimbursed medical expenses and a personal needs allowance of $105 as “patient responsibility” toward cost of care.
2. The income limit of $2199 can be overcome with a Qualified Income Trust
   1. No income limit for the spouse. The rules are built in to protect spousal impoverishment and provide for excess shelter costs, Minimum Monthly Maintenance Income Allowance (MMMIA) and spousal support.
3. Asset Limits:
   1. $2000 for individual
   2. $3000 for couple
   3. $119,220 for spouse of applicant living independently in the community
4. Transfer Rules
   1. Transfers of income or assets will affect eligibility for a period up to 60 months.
   2. Transfers to spouse or a disabled adult child are not

Aged/Disabled Adult Waiver Program (ADA Waiver)

As you see, we use a lot of acronyms and jargon. Be warned. The ADA Waiver provides home and community-based services for those who need nursing care, but can remain at home if given special services. Here are the requirements:

1. Individuals are eligible from age 18 through 64 if disabled or blind, or simply age 65 and older.
2. Individuals must meet a nursing level of care as determined by CARES
3. Must be enrolled in ADA waiver
4. Meet the same financial eligibility requirements as ICP

Assisted Living Waiver Program (AL Waiver)

The AL Waiver provides home and community- based services for those in or transitioning to assisted living facilities. The requirements are:

1. Age 18 through 64 and disabled, OR age 65 or older
2. Meet nursing level of care as determined by CARES
3. Enrolled in AL Waiver
4. Same financial eligibility requirements as ICP

Long Term Care Community Diversion Waiver (Diversion)

The Diversion Waiver provides those in need of skilled nursing care the option of receiving services from an HMO (provider) in home, in assisted living, or skilled nursing center.

1. Age 65 of age or older
2. Meet nursing level of care as determined by CARES
3. Same financial eligibility requirements as ICP
4. Enrolled in LTCCD Waiver

Florida Managed Medical Assistance Program

This program provides Medicaid for persons with high medical bills on a month by month basis after meeting share of cost.

1. There is no income limit. This is based on month by month eligibility.
2. There is an asset limit of $5000.
3. The share of cost is determined by gross income minus $20 (income disregard) and $180 Medically Needy income level which equals share of cost.

EX: $2000 -$20 -$180= share of cost per month of $1800

Other beneficial programs for those with low income and few assets:

Qualified Medicare Beneficiaries (QMB) pays Medicare Part A and B, Medicare deductibles, and co-insurance.

Special Low-Income Medicare Beneficiary (SLMB) Medicaid will pay part B premiums for individuals who have Medicare Part A, a low monthly income, and limited resources.

There is certainly more to learn, but I hope this gives you a little more understanding of what is available.

Additional resources at these websites:

http://elderaffairs.state.fl.us/doea/cares.php

http://elderaffairs.state.fl.us/doea/programs.php#questions