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Retroactive Medicaid Coverage Reduced

12-24-2018 - In a significant development for Floridians seeking Medicaid long-term care benefts, the period during which retroactive benefits are available has been reduced. Beginning February 1, 2019 those qualifying for Medicaid long-term care benefits may receive benefits for a period of 30 days prior to application. The former retroactive period was 90 days.

Florida received approval for the change from the Center for Medicare and Medicaid Services, claiming it will save the state money. Democratic legislators and advocates for the elderly have argued that the new rule will hurt the elderly and disabled. 

The 30-day retroactive rule will remain in place until June 30, at which time state lawmakers will re-evaluate it and decide if it remains in place. 

Here is an example of how the new rule applies:

Mr. Smith has been residing in a long-term care facility since February 2019. The family has been paying privately, using their own funds.  In May 2019, the family realizes that their loved one has actually been eligible for Medicaid since February 2019. They file a Medicaid application in May 2019. Assuming benefits are approved, retroactive benefits will be paid only for 30 days prior to application - in other words, they will get retroactive benefits for April 2019, not for February 2019 and March 2019. Prior to the new rule, February and March would have been covered under the 90-day rule.

The new rule increases the dangers of using a non-lawyer to handle the Medicaid application, or doing it yourself. Non-lawyers may not be aware of the new rules, and any legal foot-dragging could cost a family many thousands of dollars in lost benefits. It also demonstrates why Medicaid planning in advance is wise. and why it's important to keep your paperwork organized and ready to go.

To read more about eligibility requirements for Florida Medicaid long-term care benefits, click here.

To read about the documents you will need to apply for benefits, click here. 

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