The Money Runs Out While Mom Is in Assisted Living — What Happens Next in Florida

In this article

1. Rule out the wait and see plan first
2. Find out where she stands at her community
3. The part that works against us
4. The order to work through it
5. Other income that can stretch the money
6. If family is helping in the meantime
7. If she has to move

When a parent's savings are about to run out in Florida assisted living, the next step is almost always one of four things: switching to Medicaid at the community where she already lives, adding the state supplement or a VA benefit to her income, having family cover a set share for a set time, or moving to a community that accepts Medicaid. Which one works depends on two facts you can find out this week: whether her community accepts Medicaid, and how many months of private pay she has left.

Rule out the wait and see plan first

The most common mistake is waiting for the money to run out before calling anyone. By then, every option takes longer than the money lasts.

Medicaid's long term care program does not start the day she runs out. Her finances go to the Florida Department of Children and Families, her care needs are screened by the state, and then she goes onto a list. Under section 409.979 of the Florida Statutes, the Department of Elder Affairs releases people from that list by a priority score based on frailty, and only as funding allows. Living in assisted living already does not move her to the front.

Florida also stopped paying back the months before an application for most adults. The Agency for Health Care Administration ended retroactive Medicaid eligibility for adults 21 and older who are not pregnant in 2019, so coverage starts no earlier than the month the application arrives. A family that files late pays the gap out of pocket.

So count backward. Add up what she has, divide by her monthly bill, and if the answer is a year or less, start the calls below now.

Find out where she stands at her community

Her contract is the place to start. Florida's assisted living contract law, section 429.24, requires every contract to spell out the services, the rates, the refund policy, and at least 30 days of written notice before a rate increase. Pull it out and look for three things: the current monthly rate, any increase you have been told about, and anything about how the community handles a resident whose payment source changes.

Then ask the administrator these questions, and ask for the answers in writing:

1. Does the community accept Medicaid at all?
2. If it does, will it accept Medicaid for a current resident who started as private pay?
3. Is there a Medicaid supported room available now, or a waiting list for one?
4. What happens to her room, and her rate, during the months her application is pending?

A community that answers all four plainly is giving you something you can plan around.

The part that works against us

Here is the hard fact, and it applies to us as much as anyone. A Florida community decides for itself whether to accept Medicaid. If hers does not, she will eventually have to move once the private money is gone, however long she has lived there and however settled she is.

And even a community that does accept Medicaid, ours included, may not have a Medicaid supported room open in the month her money ends. Approval from the state does not reserve a room anywhere. That is why the questions above come before anything else, and why starting early matters more than any other step on this page.

Sugarmill Manor in Homosassa and The Gardens in Crystal River both accept Medicaid, in assisted living and in the secured memory care section. Our page on assisted living that accepts Medicaid in Citrus County explains how that works at both. If you are weighing a move to a community that can carry her through the change, ask us the four questions above before you decide anything.

The order to work through it

Rows three and four go to different offices, and neither one will tell you about the other, so make both calls the same week.

Other income that can stretch the money

Medicaid is the main answer, but two smaller programs can add to her monthly income while you work on it.

Florida's Optional State Supplementation is a cash payment for some low income residents of licensed assisted living, paid through DCF. Our guide to the Florida state supplement for assisted living covers who qualifies.

If she or her late spouse served in wartime, the VA pension with Aid and Attendance can help pay for care. The VA's own page on Aid and Attendance lists the rules, and a county veterans service officer can help file for free.

Neither one usually covers the whole bill. Each can buy months, and months are what this situation runs short of.

If family is helping in the meantime

Many families cover the gap between the last private month and the first Medicaid month themselves. That works best as a plan with an end date, not an open promise.

Write it down between you: who pays what share, starting when, and until which event, such as her long term care enrollment. Three siblings each covering a third until Medicaid begins is something everyone can stick to. One sibling quietly paying with no end in sight is how families end up arguing at the worst possible time.

If she has to move

If her community will not accept Medicaid, plan the move on your schedule rather than waiting for a notice. Under section 429.28 of the Florida Statutes, a resident is entitled to at least 45 days of written notice before a move that is not a medical emergency, and the reasons have to be in writing. That is a floor, not a plan. Forty five days is very little time to find an opening, finish a Medicaid application, and move a parent who may be living with memory changes.

When you look, compare what matters for this situation first: whether the new community accepts Medicaid for her level of care, whether it has a room for her now, and what she would pay privately if her enrollment is still pending on move in day. We publish a starting price for every room, so you can see a private month's cost before you call. Our Citrus County assisted living guide shows which communities in the county accept Medicaid, side by side.

For the wider picture of every way Florida families pay, including long term care insurance and selling a home, our guide to what to do if you cannot afford assisted living in Florida walks through each one. And if you would rather write than call, our contact page reaches the same people who answer the phone.

Frequently asked questions

What happens when someone runs out of money in assisted living in Florida?

If the community accepts Medicaid for current residents, she can usually switch to Medicaid and stay once she is enrolled in the long term care program. If it does not, she will need to move to a community that does. Start the Medicaid paperwork months before the money ends, because the program has a waitlist.

Can an assisted living community make my mom leave when she runs out of money?

A Florida community chooses whether to accept Medicaid, so one that does not can end a residency once private payment stops. State law requires at least 45 days of written notice before a move that is not a medical emergency, with the reasons in writing. The Long Term Care Ombudsman Program at (888) 831-0404 can review a notice for free.

When should we apply for Medicaid if savings are running low?

When roughly six months of private pay remain. Florida does not pay back the months before an application for most adults, and the long term care program releases people from its waitlist by priority score, so filing late means paying the gap out of pocket.

Does living in assisted living already move my parent up the Medicaid waitlist?

No. Florida releases people from the long term care waitlist by a priority score based on frailty, and only as funding allows. Call the Elder Helpline at (800) 963-5337 to request the screening that sets her score.

Sources

• Florida Statutes section 429.28: resident bill of rights, including notice of relocation
• Florida Statutes section 429.24: assisted living contracts and rate increase notice
• Florida Statutes section 409.979: long term care program eligibility and enrollment priority
• Florida Agency for Health Care Administration: Medicaid retroactive eligibility
• U.S. Department of Veterans Affairs: VA Aid and Attendance benefits
• Centers for Medicare and Medicaid Services: Long Term Care Ombudsman of Florida

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Written by

Cameron Hernando Clark

Community Relations Director

Cameron Hernando Clark is the Community Relations Director for The Manors of Citrus. He writes this family guide to help Citrus County families make sense of assisted living and memory care, drawing on the day to day of running two family owned communities on Florida's Nature Coast.