Medicaid ICP Enrollment for Nursing Home Care
Medicaid ICP Enrollment for Nursing Home Care
The Institutional Care Program (ICP) is a Medicaid program designed to aid individuals in meeting the cost for nursing home care. Florida’s Department of Children and Families (DCF) administers the enrollment for (ICP). Although Florida’s Agency for Health Care Administration (ACHA) is in theory responsible for the State’s entire Medicaid program administration, an applicant will interact directly with DCF for eligibility determination and application approval.
For more information on the agencies above go to:
It may be useful to consider how most ICP applicants come to the point of needing Medicaid assistance. Often, these are middle income and even upper middle income folks, who have never received or considered public assistance in the past. However, the daunting fiscal responsibility of an average nursing home cost in Florida is estimated at $7,500.00 to $9,000.00 per month for a semi-private room. This fact can cause most to consider Medicaid assistance when paying for nursing home care. Usually, patients enter the nursing home after a hospital stay. Traditional health care insurance does not cover a nursing home stay for custodial purposes. Even with senior adult patients, the Medicare coverage and supplemental health care insurance coverage available in the nursing home is limited. Best case, the Medicare patient may expect up to 20 days of nursing home coverage after a three-day hospital stay, followed by an additional reduced benefit of up to an additional 80 days, with supplement health insurance or private patient contribution picking up the co-pay responsibilities during that second 80-day max period. In the real world, if the Medicare patient is deemed not to be making rehabilitative progress in the nursing home (e.g., refuses or is unable to progress towards release via engaging in physical and occupational therapy sessions), then the Medicare and supplemental insurance benefit may cease early, and at that point forward the nursing home patient is private pay or on Medicaid ICP.
Medicaid ICP enrollment is not automatic. It must be applied for by or on behalf of the applicant/patient, and it must be granted by DCF based on eligibility guidelines. A basic chart showing the program’s asset and income limits is published in January and July of each year. DCF considers and evaluates all of the applicant/patient’s assets, income, prior transfers to family and others, home and home value, debts, long term care insurance, and family needs. It is important to speak to an Elder Law attorney to help guide you through DCF’s eligibility standards and processes.
Eligibility Guidelines: http://www.dcf.state.fl.us/programs/access/docs/ssifactsheet.pdf
Basic Chart cited above: http://www.dcf.state.fl.us/programs/access/docs/ssi_fin_elig_chart.pdf.
Back in the day, ICP applications were made directly to the county service center for DCF. It was possible to meet with a case worker and get a brief preview of the application process via discussions with the case worker. Additionally, applications and supporting documentation (the applicant’s family information, assets, income, expenses, and debts) were submitted directly to a local case worker.
Now, the application process is impersonal and completed via an Internet portal. Once the application is submitted, a DCF case worker is assigned and the applicant or the applicant’s representative or agent may be asked for additional supporting information on a moment’s notice. Most experienced Elder Law attorneys foresee this and employ the “old school” approach of building a detailed and comprehensive supporting documentation file for each ICP applicant whom they represent. This allows for a prompt response and avoids further delays for the applicant. Having representation from an experienced Elder Law attorney will help alleviate stress during the application process. Social workers for nursing homes may also submit basic ICP applications on behalf of existing patients in residence though they are unable to give legal advice.
More information on the application process can be found at: http://www.dcf.state.fl.us/ess/
Rarely does the patient or the patient’s family member directly file for this public assistance benefit. More often than not, either a social worker at the nursing home, an Elder Law attorney, or a private social worker/financial planner, whether licensed or not, completes and submits the online application for the applicant. If all of the surrounding circumstances affecting the applicant and family are not considered, the application could be denied and cost the applicant a good deal of money to fix the defect in the application.
One of the absolute worst moves that anyone can make is applying for the ICP benefit too early before properly considering all of the requirements and standards. For example, DCF looks back five years from the date of application, aggregates all such transfers, and denies the application based on the existence of the prior transfers. DCF then calculates when the applicant will be eligible for Medicaid assistance. That process is the total amount of transfers, divided by the monthly divisor ($9,171 as of July 2018). Once the applicant has that number he/she must decide whether it is better to privately pay until the applicant is no longer disqualified or cure the transfers thus shortening the time period of ineligibility. An experienced Elder Law attorney can anticipate all of this prior to filing and will be able to save an applicant time and money throughout the process. This example further illustrates why planning and coordination is necessary and how ill-advised it is to blindly submit an ICP application.
Another “too-soon” scenario applies to a husband and wife, when just one of the spouses needs the ICP benefit. There are two primary goals here, in addition to getting the ICP applicant approved. The first is to keep as much of the applicant’s monthly income at home as is possible with his or her spouse. The second is to keep as much wealth (i.e., assets) at home as possible with his or her spouse. Charging ahead blindly with a quick ICP application may result either in a denial of the application if the stay at home spouse is deemed to have too much in the way of “countable assets” (representing wealth kept at home). Another negative result may be in a lost opportunity to keep more of the applicant/institutionalized spouse’s income at home than otherwise would be possible without prior planning with an Elder Law attorney, in advance of the Medicaid ICP application submission.
As you can see there are many pitfalls and difficulties that can arise out of the ICP application process. The consumer’s best bet is to plan in advance with a qualified Elder Law attorney who diligently and zealously represents his or her client’s interests within the bounds of the law.
Don’t be a victim of one size fits all planning. Know your legal rights on Medicaid ICP planning and applications through an experienced Elder Law attorney and act accordingly!