Liquidating assets before medicaid
Faced with the continuation of mounting costs of health care, coupled with the state’s interest in high-quality care, the Legislature has determined that there is a need to explore alternative methods for the delivery of health care services, with a view toward achieving greater efficiency and economy in providing these services. A certified actuary shall: As to any applicant whose business plan indicates that it will receive Medicaid funds, a list of all contracts and agreements and any information relative to any payment or agreement to pay, directly or indirectly, a consultant fee, a broker fee, a commission, or other fee or charge related in any way to the application for a certificate of authority or the issuance of a certificate of authority, including, but not limited to, the name of the person or entity paying the fee; the name of the person or entity receiving the fee; the date of payment; and a brief description of the work performed. The attestation of assignment of benefits may be in written or electronic form. If an overpayment determination is the result of retroactive review or audit of coverage decisions or payment levels not related to fraud, a health maintenance organization shall adhere to the following procedures: All claims for overpayment must be submitted to a provider within 30 months after the health maintenance organization’s payment of the claim.
Health maintenance organizations, consisting of prepaid health care plans, hereinafter referred to as “plans,” are developing rapidly in many communities. The contract, agreement, and related information shall, if requested, be provided to the office. Payment to the provider from the health maintenance organization may not be more than the amount that the insurer would otherwise have paid without the assignment. A provider must pay, deny, or contest the health maintenance organization’s claim for overpayment within 40 days after the receipt of the claim.
The Board reports annually to the Congress on the financial status of the trust funds.
In order to qualify for Medicaid, one must generally be over 65 years old.
If a person has over this income, an income cap trust can usually be drafted to cure the problem.
In some cases, if a person qualifies as disabled for Social Security purposes, and has the necessary work history (in general, if the person has worked for five of the last ten years before becoming disabled), the person may be eligible for Medicaid even if under age 65.
These funds are accounts managed by the Department of the Treasury.
They serve two purposes: (1) they provide an accounting mechanism for tracking all income to and disbursements from the trust funds, and (2) they hold the accumulated assets.
Although it is the intent of this act to provide an opportunity for the development of health maintenance organizations, there is no intent to impair the present system for the delivery of health services. After submission of the application for a certificate of authority, the entity may engage in initial group marketing activities solely with respect to employers, representatives of labor unions, professional associations, and trade associations, so long as it does not enter into, issue, deliver, or otherwise effectuate health maintenance contracts, effectuate or bind coverage or benefits, provide health care services, or collect premiums or charges until it has been issued a certificate of authority by the office. 641.3154 and 641.513 with respect to services provided and payment for such services provided pursuant to the subsection. Failure to pay or deny overpayment and claim within 140 days after receipt creates an uncontestable obligation to pay the claim.On the other hand, if a couple is married, and neither has yet qualified for Medicaid, all of the non-exempt assets of either spouse (regardless of the name on the deed, title, or other asset) are considered available to pay for the cost of care.As outlined below, a portion of these available assets may be saved for the benefit of the well spouse.641.35, Florida Statutes (2000), through December 31, 2005. The study shall be for the greater of 3 years or until the health maintenance organization has been projected to be profitable for 12 consecutive months. A controlled substance, a prescription drug dispensed in an unbreakable package, or a multidose unit of a prescription drug may not be partially filled for the purpose of aligning refill dates. If the organization submits additional information, the organization must, within 35 days after receipt of the request, mail or electronically transfer the information to the provider.Assets acquired on or after June 30, 2001, shall be accounted for in accordance with the National Association of Insurance Commissioners Accounting Practices and Procedures Manual effective January 1, 2001. The study must show that the health maintenance organization would not, at the end of any month of the projection period, have less than the minimum surplus as required by s. The health maintenance organization shall pay a full dispensing fee to the network pharmacy for each partial refill of a covered prescription drug dispensed to align refill dates, unless otherwise agreed to by the plan and the network pharmacy at the time a subscriber requests medication synchronization. The provider shall pay or deny the claim for overpayment within 45 days after receipt of the information.