04 Feb THREE RECENT CHANGES TO THE MEDICAID MANUAL IN FLORIDA
I. INDIVIDUALS WITH HOMES IN ANOTHER STATE ESS 1640.0543.02 (MSSI)
“Individuals who meet Florida’s residency requirements solely because they are institutionalized in a Title XIX Medicaid facility in Florida, but who have a home in another state, may have that home excluded as an asset if:
- the individual’s spouse or dependent relative resides in the house; or
- the individual expresses the intent to return to that home (that is, the home continues to be the individual’s principal place of residence).
Statements of intent to return or allegations of dependency are accepted without further development (unless questionable) from the individual, designated representative, and the dependent relative if the individual is incapable of providing such information.”
COMMENTARY: For many years the State of Florida only excluded as an asset an out of state home if located in one of twenty states that had an interstate agreement with Florida excluding the home in that state as an asset when applying for ICP Medicaid in Florida. This amendment to ESS 1640.0543.02 extends the exclusion of an out of state home to all fifty states, by removing the list of twenty states in the original rule.
Since this rule refers to “home in another state,” what if the home was in another country? Also, if the applicant has a spouse, but the home was in another country, would that home be excluded?
II. PERSONAL NEEDS ALLOWANCE ESS 2640.0118 (MSSI)
“The amount of the individual’s income which is designated as a personal needs allowance (PNA) varies by program.
The ICP and institutionalized MEDS-AD, the personal needs allowance is $105.00, …”
COMMENTARY: Prior to this rule change, the PNA for ICP and institutionalized MEDS-AD, was $35.00. This amount has stayed the same for over twenty years. The rule change increased the amount in one large jump from $35.00 to $105.00. There does not appear to be a mechanism for increasing this amount other than by policy change from time to time. This approach is in contrast to the state’s penalty divisor which is increased every year by determining the average monthly private rate of all nursing homes in Florida and dividing that number into the value of all assets transferred by an applicant within the five year “look back” period to arrive at the length of the penalty period. This year’s penalty divisor is $8,346.00.
III. UNCOVERED MEDICAL EXPENSES ESS 2640.0125.01 (MSSI)
“The policy described below will be applied in considering medical expense deductions for institutionalized medical care in the post-eligibility treatment of income. An uncovered medical expense deduction is allowed for premiums, deductibles, co-insurance and health insurance payments from an institutionalized individual’s income to determine the patient responsibility.”
In addition to the above, other incurred medical expense deductions for institutionalized individuals in the post-eligibility treatment of income will be allowed where the service or item claimed as a deduction (a) is for a medical or remedial care service recognized under state law; (b) is medically necessary; (c) has been incurred no earlier than the three month period preceding the month of application and only if the service is anticipated to recur; and (d) has not been paid for under the Medicaid State Plan.
COMMENTARY: The change in the rule allow for payments owed to a nursing home or paid by the recipient of services or by a third party using the recipient’s funds, and incurred no earlier than the three month period preceding the month of application and only if the service is anticipated to recur. Uncovered medical expenses can be deducted in equal amounts from patient responsibility over the next six months. However, if the penalty period is due to a transfer of assets, then payment during the penalty period shall not be treated as uncovered medical expenses. Although not in the actual rule, by unwritten policy, if the payments are so great that they exceed the patient responsibility and there remains a balance of uncovered medical expenses after six months, then the remaining balance can be deducted from patient responsibility over the next six months.
For more information on medicaid, contact our Miami office for a free phone consultation at 305-274-0955.