Continuing Care Retirement Communities and Medicaid in Florida

“Will Medicaid help pay for my retirement community costs?” It’s one of the most common questions we hear.

Planning for retirement living options can feel overwhelming. Many Florida seniors consider Continuing Care Retirement Communities (CCRCs) but worry about the costs. With entrance fees that can reach $400,000 or more, plus monthly fees, it’s natural to wonder if Medicaid might help cover these expenses.

Let’s look at how CCRCs work with Medicaid in Florida and what you need to know before making this important choice.

What Are Continuing Care Retirement Communities?

CCRCs (also called Life Plan Communities) offer a complete package for seniors. They provide different levels of care all in one place, from independent living to assisted living to nursing home care.

The big idea is that you can move in while you’re still active and independent. Then, if your health changes, you can get more help without having to move to a whole new place. You stay in the same community with the same friends and familiar surroundings.

Most CCRCs in Florida charge a large entrance fee plus monthly payments. In return, they promise to provide care for the rest of your life, no matter what level of care you need.

Does Medicaid Pay for CCRCs?

Here’s the short answer: Medicaid usually doesn’t pay for the entrance fee or most monthly costs at a CCRC. But there are some important exceptions.

According to the Florida Department of Children and Families, which determines eligibility to Florida’s Medicaid program, Medicaid generally doesn’t cover:

• The entrance fee for a CCRC
• Monthly fees for independent living
• Amenities and services like meals, housekeeping, or activities

However, Medicaid might help pay for:

• Skilled nursing care within the CCRC
• Some assisted living services in certain cases

This limited coverage is why it’s so important to know how CCRCs and Medicaid work together before you make any decisions.

How CCRC Contracts Affect Medicaid Eligibility

CCRCs offer different types of contracts, and your choice can affect whether you might qualify for Medicaid later:

1. Type A (Extensive) Contracts

These are “all-inclusive” contracts with the highest entrance and monthly fees. They cover independent living, assisted living, and nursing care without big increases in your monthly fee when you need more care.

The catch? These high entrance fees might make you ineligible for Medicaid because they count as an asset. Plus, since nursing care is already included in your contract, you might not need Medicaid anyway. This is where you will need help from an elder law attorney, especially if available funds are getting low.

2. Type B (Modified) Contracts

These have lower entrance and monthly fees than Type A. They include some healthcare, but only for a limited time or with additional costs when you need more care.

You might qualify for Medicaid sooner with this type of contract if you need extended nursing care.

3. Type C (Fee-for-Service) Contracts

These have the lowest entrance fees. You pay the market rate for assisted living or nursing care when you need it.

With these contracts, you might qualify for Medicaid sooner if you need nursing care, since you’ll be paying the full cost out-of-pocket until your assets are low enough to qualify.

CCRCs and Medicaid Planning

The timing of when you move to a CCRC matters a lot for Medicaid planning. If you think you might need Medicaid in the future, consider these points:

• The entrance fee you pay to a CCRC might be counted as an asset for Medicaid eligibility purposes
• Large entrance fee payments within 5 years of applying for Medicaid could trigger a penalty period (this is called the “lookback period”)
• Some CCRCs offer partial refunds of entrance fees, which could affect your Medicaid eligibility
• The type of CCRC contract you choose affects how quickly you might qualify for Medicaid

This is where an elder law attorney can be incredibly helpful. They can look at your specific situation and help you plan the best approach.

CCRCs vs. PACE

It’s worth comparing CCRCs to another option called PACE (Program of All-Inclusive Care for the Elderly).

Unlike CCRCs, PACE:

• Doesn’t require a large entrance fee
• Is designed for seniors who qualify for nursing home care but want to stay in their own homes
• Is often covered by Medicaid for eligible seniors
• Provides healthcare, transportation, meals, and other services

PACE might be a better option for seniors with limited assets who want to stay in their existing home, while CCRCs appeal more to those who want to move to a new community with guaranteed future care.

Frequently Asked Questions About CCRCs and Medicaid

If I move to a CCRC, can I still apply for Medicaid later?

Yes, but your entrance fee and monthly payments might affect when you qualify. The type of contract you choose also matters.

Can I protect any assets if I want to move to a CCRC and might need Medicaid later?

Yes, there are legal ways to protect some assets while planning for both CCRC costs and possible future Medicaid needs. This requires careful planning, ideally before you make any large payments.

Do all CCRCs in Florida accept Medicaid for their nursing care sections?

No. Some CCRCs are Medicaid-certified for their nursing care units, but others are private-pay only. This is a crucial question to ask before choosing a community.

What happens if I run out of money while living in a CCRC?

The answer depends on your contract. Some CCRCs have financial assistance funds for residents who outlive their assets. Others might ask you to leave or move to a different section. Check the contract carefully before signing.

Making the Right Choice for Your Future

CCRCs offer wonderful benefits – a stable community, guaranteed care for life, and peace of mind. But they come with significant costs that Medicaid generally won’t cover until you need nursing-level care.

Before deciding on a CCRC:

• Review your finances carefully to make sure you can afford the costs long-term
• Read the contract thoroughly to see what happens if you run out of money
• Check if the CCRC’s nursing section accepts Medicaid
• Consider talking with a long-term care planning attorney about how a CCRC fits into your overall plan

Are you trying to figure out if a CCRC is right for you, or how it might work with Medicaid?

Our team at Berg Bryant Elder Law Group works with Florida seniors every day on these exact questions. We can help you look at all your options and make a plan that gives you both the care you need and the financial security you deserve. Give us a call to start the conversation.