Florida residents who apply for Medicaid nursing home benefits should be aware that the eligibility requirements change frequently. Two key numbers have changed effective July 1, 2024:
Minimum Monthly Maintenance Needs Allowance (MMMNA)
This rule change applies to married couples when one spouse is in a nursing home and receiving Medicaid benefits. The spouse who is not in a nursing home is called the “community” spouse (or well spouse).
Medicaid allows a portion of the nursing home resident’s income that would otherwise go to the nursing home to be diverted to the community spouse if the community spouse’s income falls below a certain level. The amount that may be diverted is the amount needed to elevate the community spouse’s income level to the Minimum Monthly Maintenance Needs Allowance, or MMMNA. Effective July 1, 2024, the MMNA has increased to $2,555 (up from $2,465). The MMMNA is based on federal poverty guidelines and is adjusted for inflation.
There are certain special circumstances – for example, high housing expenses or utility expenses – when income may be diverted to bring the community spouse’s income as high as $3,854 (up from last year’s number of $3,715.50). This amount can be even higher if there is a court order of support for the spouse.
Here is an example of how MMMNA works: Mr. Smith is married and resides in a nursing home. He is receiving Florida Medicaid benefits. His monthly income is $6,000. From that $6,000, he can pay his Medicare fees and other health insurance, and may also take $160 per month for his Personal Needs Allowance. Mrs. Smith, the community spouse, has a gross monthly income of $2,000, which falls $555 short of the MMMNA. Therefore, $555 of Mr. Smith’s may be diverted to Mrs. Smith each month. The remainder of Mr. Smith’s income will go to the nursing home.
Penalty Divisor
The penalty divisor is $10,438 effective July 1, 2024. Medicaid uses the penalty divisor to determine the length of time an otherwise eligible applicant will not receive benefits if the applicant made any uncompensated transfers in the five year period preceding application.
Illustration of how the penalty divisor works: Diane transferred $10,438 to her son in December 2021 and $10,438 to her daughter in January 2022. She then applies for Medicaid in September 2024. She meets all eligibility requirements except for the uncompensated transfers she made during the five-year look-back period. The penalty period begins to run at the time of application. Thus, Medicaid will deem her ineligible for benefits for the next 2 months (sum of $10,438 and $10,438, divided by $10,438 per month exemption = 2 months). She will be eligible for Medicaid benefits, assuming she still meets all other criteria, in November 2024. She must pay out-of-pocket for nursing home expense out of pocket until that date. Note: our law firm can assist you with strategies that may eliminate that penalty period, even at the late date when someone is actually moving into a nursing home.
There are many more rules for Medicaid eligibility in Florida that apply to applicant and spouse, and the rules are always in a state of flux. If it looks like your loved one does not qualify for benefits, do not count him/her out! There are several legal strategies that may allow your loved one to access benefits and to preserve a good portion of assets before you “spend down” and lose everything. Steps can often be taken even if your loved one is already in a nursing home – in fact, this kind of crisis planning is the norm for the majority of clients we assist. To schedule a consultation with The Karp Law Firm, call (561) 625-1100.
Learn more about Medicaid benefits for long-term nursing care.
