While the concept of “nursing homes” may seem outdated, assisted living and memory care centers are a different matter. These modern facilities offer personalized services and independence without jeopardizing a senior’s health or safety, which might be the best option to protect your senior family member long into the future. Unfortunately, laws and financial assistance programs have not modernized at the same rate – still, some programs like Medicaid are available to help and can make a difference. However, it is necessary to know how these programs work and what they cover.

Medicaid, Medicare, and Common Issues Regarding Complexities of Senior Care Costs

There is typically some confusion about what Medicaid and Medicare will cover for seniors needing help. These two programs may sound similar, but they serve very different purposes, especially regarding what they pay for and how they pay for it.

Medicare focuses on short-term medical care, such as doctor visits or rehabilitation after surgery. It doesn’t cover the cost of long-term residential care, like memory care or assisted living in Florida, which may surprise families when those bills start piling up. There are some limited exceptions for temporary care in nursing homes, however.

On the other hand, Medicaid was created to help low-income individuals pay for healthcare, and it allows for some forms of long-term care. Florida’s Statewide Medicaid Managed Care Long-Term Care Program is the specific assistance program that Florida seniors can use if they need help with daily activities or have memory-related conditions.

However, there are limitations. Medicaid typically doesn’t pay for room and board in assisted living or memory care facilities. In addition, not all facilities accept Medicaid. However, the financial benefit of Medicaid can simply be put towards other aspects of the monthly cost, allowing seniors and their families to handle a much smaller bill for just room and board.

Preparing for a Senior’s Stay in Memory Care or Assisted Living

Planning for senior care is rarely straightforward. Families often struggle between managing current expenses and preserving their loved one’s savings. We recommend working with a professional estate law attorney to address your concerns and ensure your loved one can pay for their care over time. Some of the issues you can expect to address and find solutions for include:

Income and Asset Requirements: The Florida 2024 income limit for a single applicant is about $2,800 per month, and countable assets cannot exceed $2,000. However, some assets, like a primary residence and personal vehicles, may be exempt. If income or assets exceed these limits, families may need to explore legal strategies to “spend down” excess resources or restructure them to comply with Medicaid’s rules.
Spousal Protections: When one spouse needs assisted living or memory care, the financial situation for the other—known as the “community spouse”—is complex. However, it’s just as important, and you can’t ignore those issues. Medicaid allows the healthy spouse to retain a portion of the couple’s assets and income.
Trusts and Asset Protection Strategies: Trusts, particularly irrevocable Medicaid asset protection trusts, work to shield assets from being counted toward Medicaid eligibility. Since trusts help fund medical care without jeopardizing a senior’s enrollment, additional financial requirements exist. For example, Medicaid enforces a five-year look-back period, and any transfers made within this period could result in penalties or delays in eligibility.
Power of Attorney and Legal Decision-Making: A power of attorney set up on behalf of your senior family member gives a trusted individual the authority to act quickly when that senior is incapacitated and cannot make decisions. Since many of Medicaid’s requirements check finances and assets monthly, families relying on Medicaid coverage to help pay for care costs generally want a clear power of attorney and an actionable plan for what to do when something unexpected occurs.
Costs Beyond Medicaid Coverage: While Medicaid can cover many care-related services, it does not typically pay for everything. Families should look into long-term care insurance, possible veterans’ benefits, or asset leverage to find ways to pay for care. The earlier you plan, the less burdensome monthly costs will be.

If you’re considering assisted living or memory care for a loved one, start the conversation today. Work with professionals, discover how Medicaid can help, and then contact A Banyan Residence to learn what we offer seniors needing daily assistance. We look forward to speaking with you and your family.