Florida
What Is Florida Medicaid Long-Term Care?
Florida Medicaid offers healthcare coverage for low-income individuals, including seniors aged 65 and older. How does it help seniors who need long-term care? In addition to nursing home services, it also covers care in assisted living, adult family care homes, and even non-medical services provided in the home.
What Types of Long-Term Care Programs Does Florida Medicaid Offer?
Florida Medicaid offers three main categories of long-term care for seniors:
What Is Institutional / Nursing Home Medicaid?
This is a guaranteed benefit program for eligible individuals. What does it provide? Nursing home care for those who meet the income, asset, and medical need criteria.
What Are Medicaid Waivers / Home and Community-Based Services (HCBS)?
These are limited-capacity programs that aim to delay or avoid nursing home placement. What services are available? In-home care, adult day care, assisted living, and adult foster care via managed care plans.
What Is Regular Medicaid / Medicaid for Aged and Disabled (MEDS-AD)?
This entitlement program offers limited long-term support for eligible seniors. What kinds of services are included? Assistance with personal care or participation in adult day programs.
Who Oversees Florida’s Medicaid Programs?
What is the administrative structure? Florida’s long-term care Medicaid services are delivered through the Statewide Medicaid Managed Care (SMMC) system. The long-term care component is called the LTC Program, while other health services are covered under the Managed Medical Assistance (MMA) Program. The Florida Agency for Health Care Administration oversees both.
What Are the Financial Eligibility Requirements for Florida Medicaid Long-Term Care?
Each long-term care option has different requirements. What are the key criteria? Income, assets, marital status, and medical need all factor in.
What Are the 2025 Financial Limits for a Single Applicant in a Nursing Home?
- Income must be below $2,901/month
- Assets must not exceed $2,000
- Applicant must require a nursing home level of care
What Are the 2025 Medicaid Income and Asset Limits by Program Type?
| Medicaid Type | Income Limit | Asset Limit | Care Requirement |
|---|---|---|---|
| Nursing Home Medicaid | $2,901/mo | $2,000 | Nursing Home |
| HCBS Waivers | $2,901/mo | $2,000 | Nursing Home |
| Regular Medicaid (MEDS-AD) | $1,149/mo (eff. 4/1/25) | $5,000 | Help with ADLs |
How Does Florida Medicaid Count Income?
What Is Countable vs. Non-Countable Income?
Most income from any source is counted. This includes Social Security, pensions, wages, and IRA withdrawals. However, VA Aid & Attendance and Holocaust restitution payments are not included.
How Is Income Treated for Married Couples?
When one spouse applies for Medicaid, only their income is counted for Nursing Home Medicaid and HCBS. The non-applicant spouse may receive part of the applicant’s income through the Minimum Monthly Maintenance Needs Allowance (MMMNA), set at $2,644 (2025), capped at $3,948. In Regular Medicaid, both spouses’ incomes are counted, and there is no MMMNA.
How Are Assets Evaluated for Florida Medicaid?
What Are Countable and Non-Countable Assets?
Countable assets include bank accounts, stocks, and non-resident real estate. Exempt assets include one home (within equity limits), one vehicle, personal effects, and IRAs in payout status.
How Are Assets Treated for Married Couples?
All assets are considered jointly owned. The non-applicant spouse can retain up to $157,920 in 2025 under the Community Spouse Resource Allowance (CSRA). There is no CSRA for Regular Medicaid.
What Is Florida Medicaid’s Look-Back Period?
Florida has a 60-month look-back period for Nursing Home Medicaid and HCBS. Any asset transfers for less than fair market value during this period may result in a penalty of Medicaid ineligibility.
Can a Home Be Exempt from Medicaid Consideration?
A home is exempt if the applicant or spouse lives there and the equity is below $730,000 (2025). If neither resides in the home, the applicant must declare Intent to Return. After death, the home may be subject to Medicaid estate recovery.
What Medical or Functional Needs Are Required?
Applicants must need assistance with activities of daily living (ADLs) or demonstrate a need for a nursing facility level of care (NFLOC), depending on the program.
What If a Person Has Too Much Income or Too Many Assets?
What Is the Medically Needy Pathway?
Applicants with high income may qualify by spending down medical expenses to reach the Medically Needy Income Limit (MNIL): $180/month for singles and $241/month for couples in 2025.
What Is a Qualified Income Trust (QIT)?
A QIT (Miller Trust) allows applicants to deposit excess income into an irrevocable trust to qualify for Medicaid. Florida must be named as the beneficiary for remaining funds.
How Can Excess Assets Be Spent Down?
Applicants can legally spend excess assets on non-countable items like home improvements or medical equipment. Gifting assets is not allowed and may violate Medicaid’s look-back rule.
What Is Medicaid Planning?
Professionals help applicants legally restructure finances to qualify for Medicaid and protect assets like the family home from estate recovery.
What Specific Florida Medicaid Programs Help Seniors Remain at Home?
Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) Program
This program has replaced previous waivers like the Alzheimer’s and ALE Waivers. Services may include adult day care, meals, respite care, personal care, and emergency response systems.
Program of All-Inclusive Care for the Elderly (PACE)
PACE combines Medicaid and Medicare into a single plan that may also include dental, vision, and other services to help seniors remain at home.
How Can Seniors Apply for Florida Medicaid?
Applications can be submitted online via MyACCESS Florida, by downloading a paper form, or by calling 1-866-762-2237. Applicants should ensure they meet eligibility criteria beforehand or seek help from a Medicaid planner.
