No More Retroactive Medicaid?

The State of Florida has ask the Federal government Centers of Medicare and Medicaid Services (CMS) to waive retroactive coverage protection for Floridians age 21 and over who are eligible for Medicaid.

Currently if a nursing home resident is approved for Medicaid you are allowed to seek coverage not only for the month you filed the application but for up to three months prior to the Medicaid application when the resident would otherwise meet all of the Medicaid eligibility requirements.

The proposed request would only allow coverage to begin the month you filed the Medicaid application and met all of the Medicaid eligibility requirements.  The prior months of needed coverage would need to be paid for privately by the resident and if the resident was unable to pay the nursing home would not get paid for the care provided.  This would create a crisis for either party.

This will be difficult for many of our clients as the need for long term care Medicaid typically comes suddenly from a fall, broken bone, stroke, etc.…  The individual needing Medicaid and their family are concentrating on obtaining the best healthcare and rehabilitation.  It is often the first time the applicant and family become knowledgeable about the limitations of Medicare coverage and quickly find out how much daily care at the nursing home cost.

The application for long term care Medicaid is complicated and requires a significant amount of documentation (proof what you are saying is true).  Eligibility is determined based on one day of the month and you can obtain coverage for that entire month (and up to three months retroactively if CMS does not approve Florida’s request).

We still have time to submit comments to the website link provided: (

You may also email your comments to

Your comments may include:

  • Health care needs are unpredictable. No one can predict a stroke, a car accident, a fall leading to a broken hip.  Once you are in the hospital then require rehabilitation you are focused on your healthcare and often not healthy enough to file a Medicaid application and may not even know a Medicaid application should be filed.  Please reject the State of Florida waiver amendment and maintain the three month Medicaid retroactive coverage.

How can our law office help?

We help individuals, applicants and their families plan for Medicaid eligibility in advance as well as when the catastrophe and need strikes.  We begin with providing you a very long and thorough Questionnaire to complete.  The Questionnaire ask you all of the questions we are required to answer when filing the Medicaid application.  While it takes time and some work to complete the questionnaire it helps you get organized and enables us to give you specific advice as to what action(s) you may need to take to become eligible for Medicaid.

During our first appointment we will review the Questionnaire with you and provide specific recommendations to you as to how to become eligible for Medicaid, protect your income and assets, and review the application process.  If Medicaid planning is required (legal methods and options of protecting your assets) we will quote a fee at that time to assist you in becoming eligible for Medicaid and filing the Medicaid application.

If this amendment is approved planning for Medicaid eligibility will be more important than ever.  Planning during the crisis is a challenge for all involved.