Florida Medicaid Definition
Medicaid is a wide-ranging, jointly funded federal and state health care program for low-income individuals of any age. While there are various eligibility groups, including pregnant women, children, and disabled individuals, this page focuses on Medicaid eligibility, specifically long-term care, for Florida senior residents (aged 65 and over). In addition to care services in nursing homes, adult foster care homes, and assisted living facilities, FL Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes.
Medicaid in Florida is sometimes called the Statewide Medicaid Managed Care (SMMC) program. The Medicaid managed care program for long-term care services for the elderly and disabled is called the Long-term Care (LTC) program. All other health care services outside of long-term care are provided via the Managed Medical Assistance (MMA) program.
Income & Asset Limits for Florida Eligibility
There are several different Medicaid long-term care programs for which Florida seniors may be eligible. These programs have varying eligibility requirements and benefits. Further complicating eligibility are the facts that the criteria vary with marital status and that Florida offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.
2) Home and Community Based Services (HCBS) – These services are not an entitlement; The number of persons who can receive these services is limited and wait lists for some services may exist. Intended to delay nursing home admissions, long-term care benefits are provided at home, adult day care, in adult foster care homes, and in assisted living residences via a managed care system. Florida previously offered HCBS Medicaid Waivers for the aged, but no longer does.
3) Regular Medicaid / Medicaid for Aged and Disabled (MEDS-AD) – This is an entitlement program; All persons who are eligible will receive services. Limited long-term care services, such as personal care assistance or adult day care, may be available.
The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a Florida Medicaid program. Alternatively, one may take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in Florida. More.
|2022 Florida Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,523 / month*||$2,000||Nursing Home||$5,046 / month ($2,523 / month per spouse)*||$3,000||Nursing Home||$2,523 / month for applicant*||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Home and Community Based Services||$2,523 / month†||$2,000||Nursing Home||$5,046 / month ($2,523 / month per spouse)†||$3,000||Nursing Home||$2,523 / month for applicant†||$2,000 for applicant & $137,400 for non-applicant||Nursing Home|
|Regular Medicaid / Medicaid for Aged and Disabled||$997 / month (eff. 4/1/22 – 3/31/23)||$5,000||Help with ADLs||$1,343 / month (eff. 4/1/22 – 3/31/23)||$6,000||Help with ADLs||$1,343 / month (eff. 4/1/22 – 3/31/23)||$6,000||Help with ADLs|
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. This income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Holocaust restitution payments and Covid-19 stimulus checks are not considered income and do not impact Medicaid eligibility.
When only one spouse of a married couple applies for Institutional Medicaid or home and community based services, only the income of the applicant is counted. This means the income of the non-applicant spouse is disregarded and does not impact the income eligibility of their spouse. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment rule and is the minimum amount of monthly income a non-applicant spouse is said to require to avoid spousal impoverishment. The MMMNA is $2,288.75 (effective 7/1/22 – 6/30/23). If a non-applicant’s monthly income is under $2,288.75, income can be transferred from their applicant spouse, bringing their income up to this level.
In Florida, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $686.63 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. Learn more about how the spousal allowance is calculated.
Income is counted differently when only one spouse applies for Regular Medicaid; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid counts income.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. There are also many assets that Medicaid considers to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, IRAs in payout status, and generally one’s primary home. For home exemption, the Medicaid applicant must live in it or have intent to return, and in 2022, have a home equity interest no greater than $636,000. Equity interest is the amount of the home’s value owned by the applicant after subtracting any home debt. If a non-applicant spouse lives in the home, it is exempt regardless of any other circumstances.
All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a Medicaid nursing home or home and community based services applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, this spousal impoverishment rule allows the community spouse (the non-applicant spouse) to retain up to $137,400 of the couple’s assets, as shown in the chart above.
Florida has a 60-month Medicaid Look-Back Period that immediately precedes one’s Medicaid application date. During this time frame, Medicaid checks to ensure no assets were gifted or sold under fair market value. This includes assets transferred by one’s spouse. The look back rule is intended to prevent persons from giving away assets to meet Medicaid’s asset limit. If one violates the look-back period, a penalty period of Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Florida residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – Florida has “Share of Cost” Program, also called a “Spend-Down” Program, for persons who apply for Regular Medicaid / Medicaid for Aged and Disabled and have income over the Medicaid limit. This program allows persons to become income-eligible for Medicaid services by spending the majority of their income on medical bills (i.e., health insurance costs, such as Medicare premiums, and medical service bills). In 2022, the medically needy income limit in FL is $180 / month for a single applicant and $241 / month for a married couple. The “spend-down” amount is the difference between one’s monthly income and the medically needy income limit. Once the “spend down” is met, one will be Medicaid eligible for the remainder of the month. The medically needy asset limit is $5,000 for an individual and $6,000 for a couple.
2) Qualified Income Trusts (QITs) – Also called Miller Trusts, QITs offer a way for persons over the Medicaid income limit to still qualify for nursing home Medicaid or a Medicaid Waiver. With this type of irrevocable trust, a sufficient amount of money must be deposited into the account each month to bring the individual’s income down to the Medicaid income limit. Irrevocable means the terms of the trust cannot be changed or canceled. A trustee is named and legally controls trust funds, which can only be used for very specific purposes. Examples include paying medical bills, personal needs allowances, and Medicare premiums. The state of Florida must be named to receive any money remaining in the trust upon the death of the Medicaid recipient.
3) Asset Spend Down – Persons who have countable assets over FL’s asset limit can “spend down” assets and become asset eligible. This can be done by spending excess assets on non-countable ones. Examples include making home modifications, like the addition of wheelchair ramps or stair lifts, prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s look back rule and can result in a penalty period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.
4) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program. Read more or connect with a Medicaid planner.
Specific Florida Medicaid Programs
1) Florida’s Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program – Florida has replaced their Medicaid HCBS Waivers with a Medicaid managed care program. Former waivers, such as the Alzheimer’s Disease Waiver, Nursing Home Diversion Waiver, Assisted Living for the Elderly (ALE) Waiver, and the Consumer Directed Care Plus (CDC+) Waiver, have all been discontinued and replaced with the Statewide Medicaid Managed Care – Long Term Care (SMMC-LTC) program. Most of the services and benefits that were available under the older waiver system have been preserved with the new Medicaid managed care model. Benefits may include adult day health care, meal delivery, respite care, personal emergency response systems, and personal care assistance, to name a few. More on the SMMC-LTC program.
2) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental care and eye care, may be available.
How to Apply for Florida Medicaid
Seniors wishing to apply for Florida Medicaid can do so online via ACCESS. For additional information or application assistance, persons can contact their local ACCESS Service Center. Alternatively, persons may call the ACCESS Customer Call Center at 1-866-762-2237.
Prior to submitting a Medicaid application for long-term care in Florida, it is imperative that seniors are certain that they meet all eligibility requirements. Persons who have income and / or assets in excess of the limit(s) can benefit from Medicaid planning for the best chance of acceptance into a Medicaid program. Learn more about how the Medicaid application process works.