Florida is an "Income Cap" state. This means that if a person's gross income is over $2,199 per month, then that person is ineligible for ICP Medicaid benefits. The Agency only looks at the Applicant's income, not the Applicant Spouse's income, if married.
Note that it is the GROSS income that is considered. Therefore, the Medicaid Agency will require that Medicare Part B premiums, insurance premiums, tax deductions and other deductions be added back in.
- Example 1*: Mary is a single person who needs placement in a skilled nursing facility. Her income consists of her social security check of $700, and a small widow's pension of $300. Her Medicare Part B Premium is $104.90 per month which must be added back in to determine her GROSS monthly income. This amount is $1,104.90 per month, which is less than the income limit of $2,199.00 per month. Mary passes the income test.
- Example 2*: Elizabeth is a married woman who needs placement in a skilled nursing facility. Her income consists of her social security check of $804.90. Roger, her husband, receives social security in the amount of $1,300, and a pension of $500.00 per month. Together, their GROSS income equals $2,609.80 per month. However, only Elizabeth's GROSS income of $804.90 is considered. Roger's income is ignored.
- Example 3*: Same as Example 2, except Elizabeth's income consists of her social security check of $1,200.00 and a pension of $1,309.80 Roger, her husband, receives social security in the amount of $1,200.00, and a pension of $500.00 per month. Together, their GROSS income equals $4,209.80 per month. Again, only Elizabeth's GROSS income of $2,509.80 is considered and Roger's income is ignored. However, here Elizabeth income exceeds the Income Cap of $2,199.00.
In the event the person exceeds this amount, then a Qualified Income Trust must be established. In Example 3 above, Elizabeth
will need to establish such a trust in order to become eligible for Medicaid benefits.
Many Medicaid Offices attempt to hand out a generic Qualified Income Trust form when a family wants to file a Medicaid Application. Beware: At the very least, that office or person is engaged in the unlawful practice of law (a trust is a legal document). At its worse (which usually happens more often than not), the trust is deficient in its language, does not provide information as to how it should be maintained or how the trust bank accounts should be established and maintained, and runs the greater risk that at some point in the future, the Medicaid Agency will investigate and review the trust accounts and deny benefits retroactively.
* In all of these examples, it is assumed that the person or couple meet the asset requirements.