If you live in the state of Florida and need health insurance, you may qualify for Medicaid if you meet certain state-imposed requirements.
Medicaid is a joint program launched by the government and the state to offer medical assistance to individuals and families with low incomes.
In Florida specifically, it’s administered by the Florida Agency for Health Care Administration (AHCA) in association with the federal Centers for Medicare & Medicaid Services (CMS).
In this framework, all family members could benefit from it as it covers children, pregnant women, the elderly, and people with disabilities.
The program helps cover medical expenses related to doctor’s visits, hospital admissions, prescriptions, and other specialized healthcare services.
This program offers three plans which beneficiaries are entitled to use, noting that they could use one or more of these types of plans.
The first is Managed Medical Assistance (MMA), which most people eligible for Medicaid join and covers consultations, hospital care, prescription drugs, mental health care, and transportation to these services.
The second is Long-term Care (LTC) which includes care in a nursing facility and assisted living or at home.
To qualify, you must be at least 18 years old and meet the level of care in a nursing home, or in another case, meet the level of care in the hospital if you have Cystic Fibrosis.
The Dental plan is the last, providing all Medicaid dental services to children and adults, and it’s important to know that all people on Medicaid must enroll in a dental plan.
Medicaid applies to support women in pregnancy, those with a disability, or living in a household where someone has physical or mental limitations.
Those who are responsible for a minor or live with an elderly person 65 years of age or older can also join.
But to access it, certain essential requirements must be met, including living in the state and having legal residency or U.S. citizenship.
Likewise, to access this economic benefit in Florida, applicants must have annual family income before taxes that are less or equivalent to the following:
- Household of one member: $19,392
- Household of two members: $26,228
- Household of three members: $33,064
- Household of four members: $39,900
- Household of five members: $46,737
- Household of six members: $53,573
- Household of seven members: $60,409
- Household of eight members: $67,245
It’s important to know that the program also considers a control rule for those benefiting from Medicaid known as the “five-year rule.”
The program examines the financial transactions of applicants in three stages, a way to ensure that the applicant has not given away any assets to report lower income and thus qualify in the five years prior to the application.
The first is the look-back period in which Medicaid reviews financial transactions made by the applicant or their spouse in the five years prior to the application.
The second is known as Asset Transfers, establishing that if the program finds that the applicant or their spouse has transferred assets for less than fair market value during the look-back period, they may receive a penalty period.
During that penalty period, applicants would not be eligible for the program, and the measure would be determined by dividing the value of the transferred assets by the average monthly cost of care in a nursing home in the state.
The last, called Purpose, is driven to prevent people from artificially impoverishing themselves through these practices to qualify for Medicaid benefits.
This ensures that program benefits are received by those with genuine financial need.
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