Proving the Medical Necessity of Nursing Home Care
If you are a Florida resident, you may be able to receive Medicaid benefits when seeking to pay for nursing home costs. You must be able to prove that you require a nursing home level of care and that moving into a long-term care facility is medically necessary in your case. In order to do so, you will need to undergo a thorough examination called the Comprehensive Assessment and Review for Long-Term Care Services (CARES), during which a representative from Florida’s Department of Elder Affairs will interview you and evaluate your overall health and ability to function independently.
You may be able to obtain Medicaid assistance for nursing home costs if any of the following is true in your case:
- Nursing home care is necessary to protect your life, avoid disability or serious illness, or obtain relief from severe pain.
- Nursing home care makes sense based on your specific illness or injury and the current treatments you are receiving.
- Nursing home care is appropriate based on professional medical standards.
- Nursing home care can be safely administered and there is no equally effective and less expensive alternative treatment available in the state.
- Nursing home care does not primarily serve the convenience or preferences of the person receiving care, their family members, or the care provider.
Proving that You Are Financially Eligible to Receive Managed Long-Term Care
Personal finances also factor into your ability to pay for nursing home costs through Medicaid. You may only qualify for the state’s managed long-term care program if you meet certain criteria regarding your income and resources.
You may qualify to receive managed long-term care benefits in Florida if the following are true:
- You currently receive Supplemental Security Income (SSI); OR
- Your monthly income does not exceed the Medicaid income limit; AND
- Your assets do not exceed $2,000 (individual) or $3,000 (couple), typically excluding your home and one car.
Medicaid Lawyer in St. Petersburg
When seeking to apply for Medicaid benefits, you should always consult with a legal representative to help you navigate the process, especially since there is a strong likelihood that you could be denied and left without access to the care you need. At Finley Williams Law, PA, we can help you create a comprehensive plan to qualify for Medicaid benefits and complete the Medicaid application, increasing your likelihood of obtaining Medicaid benefits in a timely manner