Florida Medicaid Eligibility: Income, Assets, and Medically Needy

Florida Medicaid eligibility requirements work category by category: you qualify only if you fit into a specific group the program covers, and each group has its own income limit and, in some cases, an asset limit. The main categories are children, pregnant women, parents and caretaker relatives, people who are aged, blind, or disabled, and people who need long-term care. Florida has not expanded Medicaid under the Affordable Care Act, so low-income adults who don’t fall into one of those categories generally cannot get coverage no matter how little they earn.

The Agency for Health Care Administration runs the program, but the Department of Children and Families handles applications and decides who qualifies.

Income Limits by Category

Most families are measured against the federal poverty level. The 2026 poverty level for a household of three is $27,320 per year, and the percentages below scale with household size.¹

Children

Children have the widest coverage. Infants under age one qualify at family income up to 200% of the federal poverty level. Children ages one through five qualify at 133%, and children ages six through eighteen also qualify at 133%.² No asset test applies.³

Children who don’t qualify for Medicaid may still be covered under the broader Florida KidCare program, which reaches families earning up to 300% of the poverty level.⁴ A child who qualifies for Medicaid must enroll there rather than in another KidCare component.

Pregnant Women

Pregnant women qualify at family income up to 185% of the federal poverty level, which is roughly $40,034 per year for a household of two in 2026. No asset test applies.³ Coverage continues through the pregnancy and for 12 months after delivery.⁵ Applying through a qualified Medicaid provider can trigger presumptive eligibility, giving temporary coverage while the full application is processed.

A separate Family Planning Waiver covers women ages 14 through 55 at income up to 191% of the poverty level who previously lost Medicaid, for up to 24 months. It pays only for contraception, STI treatment, and related reproductive services.⁶

Parents and Caretaker Relatives

The parent category is where Florida’s income limit is unusually strict. A parent or caretaker relative qualifies only if family income is at or below roughly 26% of the federal poverty level. For a family of three in 2026, that is about $7,100 per year, or $592 per month.² Most working parents earn more than that even at minimum wage.

Aged, Blind, and Disabled

People who are 65 or older or have a qualifying disability fall under Aged, Blind, and Disabled rules. This category applies both an income test and an asset test. Countable assets cannot exceed $2,000 for an individual. Your primary home, one vehicle, personal belongings, household furnishings, and a limited amount of life insurance generally do not count.

On income, the state must cover ABD individuals at or below 100% of the poverty level for Medicare cost-sharing (premiums, copays, deductibles).³ Florida optionally covers ABD individuals at or below 88% of the poverty level for full Medicaid benefits, if they are not eligible for Medicare or are receiving institutional care, hospice, or home and community-based services.⁷

Long-Term Care (Institutional Care Program)

Nursing home coverage and home and community-based waiver services fall under the Institutional Care Program, which has its own rules. Income cannot exceed 300% of the Supplemental Security Income federal benefit rate. In 2026, that translates to $2,982 per month for an individual.⁸ The applicant’s asset limit is still $2,000.⁷

If your income is above $2,982, you can still qualify by using a Qualified Income Trust (Miller Trust). Each month you deposit enough income into the trust that what remains outside falls below the cap. Deposits must be made in the month the income is received; you cannot backfill, and skipping a month makes you ineligible for that month.⁹ Anything left in the trust at death goes to the state, up to what Medicaid paid on the person’s behalf.

When one spouse enters long-term care and the other stays at home, federal spousal impoverishment rules protect the community spouse. In 2026, the community spouse can keep up to $162,660 in countable assets. The applicant spouse is still limited to $2,000. The at-home spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance of $2,644 (July 1, 2025 through June 30, 2026); income can be shifted from the applicant to bring the community spouse up to that floor. Housing costs over $794 per month can raise the allowance, but not above a total monthly income of $4,067.

ICP also has a 60-month look-back. Florida reviews five years of financial transactions before your application date, and any transfer for less than fair market value in that window triggers a penalty period during which Medicaid will not pay for long-term care. The penalty length equals the value of the transfer divided by the average monthly nursing home cost in the area. Transferring your home to a spouse, a child under 21, a blind or disabled child, or a sibling with an ownership interest who lived in the home is exempt. So is transferring a home to an adult child who lived there for at least two years and provided care that delayed the parent’s nursing home admission. The state can grant an undue hardship waiver where a penalty would threaten health or basic necessities.¹⁰

Asset Limits: When They Apply and When They Don’t

Children, pregnant women, and parents are measured on income alone under Modified Adjusted Gross Income rules. Savings accounts, investments, and property do not count against you in those categories.

Aged, Blind, and Disabled applicants and Institutional Care Program applicants face a $2,000 asset limit. Certain assets are exempt: primary home, one vehicle, personal belongings, household furnishings, and a small amount of life insurance. The details of what counts can decide the application, which is why many families work with an elder law attorney on ABD or long-term care filings.

The Coverage Gap for Adults Without Children or a Disability

If you are between 19 and 64, not pregnant, not disabled, and not caring for a dependent child, Florida Medicaid is almost certainly not available to you at any income level. Under ACA expansion, adopted by 40 states, these adults would qualify at 138% of the poverty level. Florida did not expand, so people in that situation can earn too much for Medicaid but potentially too little for marketplace premium subsidies.

If Your Income Is Slightly Too High: Medically Needy

People who fit an eligibility category but earn slightly over the limit may still qualify through the Medically Needy program. Rather than denying you outright, the state assigns a monthly “share of cost” based on household size and income. Once your medical expenses in a given month reach the share of cost, Medicaid covers you for the rest of that month.¹¹

You can meet the share of cost with unpaid medical bills, bills paid within the last three months, health insurance premiums, copays, and medically prescribed services including ambulance transportation. Over-the-counter items like bandages and cold remedies do not count. Expenses from any household member whose income was used in the eligibility calculation can count, even if that person isn’t the applicant. One limit: Medically Needy does not cover nursing facility care or intermediate care facilities for people with developmental disabilities.⁷

Non-Financial Requirements

Financial eligibility only matters once you meet the baseline requirements.

Residency and identity. You must live in Florida and intend to stay. For MAGI categories, the state accepts self-attestation of residency unless what you report conflicts with other verification sources.¹² ABD and long-term care categories require more documentation, including a driver’s license, state ID, or similar identity document. Every applicant must provide a Social Security Number or proof of application for one.

Citizenship and immigration status. Applicants must be U.S. citizens, U.S. nationals, or qualified immigrants. Acceptable citizenship proof includes a U.S. passport, certificate of naturalization, or a U.S. birth certificate paired with an identity document.¹³ Qualified immigrants include lawful permanent residents, refugees, asylees, Cuban/Haitian entrants, trafficking victims, and certain veterans and military families.¹⁴ Most qualified immigrants wait five years after obtaining their status before accessing full Medicaid benefits; refugees, asylees, and some humanitarian groups are exempt from that wait.¹⁵ Anyone with a medical emergency can receive emergency Medicaid services regardless of immigration status.⁷

Other insurance. You must disclose any other health coverage you have. Medicaid is the payer of last resort, so private insurance, Medicare, TRICARE, and auto coverage must be billed first.¹⁶ Failing to report other coverage can put eligibility at risk.

How to Apply and What to Expect

Applications go through the ACCESS Florida system, run by the Department of Children and Families. You can apply online, by mail, or in person at a local DCF office. The same application covers Medicaid, SNAP, and temporary cash assistance.

MAGI applicants should have income documentation such as pay stubs or tax returns. ABD and long-term care applicants need bank statements, investment records, and documentation for any property they own, along with all the standard identity and citizenship proof.

Federal rules require the state to decide standard Medicaid applications within 45 days. Applications that require a disability determination can take up to 90 days. You receive a written determination notice, and if the decision is unfavorable, you can request a fair hearing within 90 days.¹⁷

Estate Recovery After Age 55

If you receive Medicaid benefits at age 55 or older, Florida is required to try to recover the cost of that care from your estate after death. The claim covers medical assistance paid after age 55. Benefits paid before age 55 do not create a recoverable debt.¹⁸

The state cannot pursue recovery if the recipient is survived by a spouse, a child under 21, or a child who is blind or permanently disabled. It also cannot recover against property that is constitutionally exempt from creditors’ claims in Florida. A personal representative or heir can request a hardship waiver, and the state weighs factors such as whether the heir lived in the decedent’s home for at least 12 months before death, owns no other residence, provided full-time care that delayed nursing home admission, or would be deprived of basic necessities.¹⁸ For families who use long-term care benefits over several years, the accumulated claim can be significant.

1
HHS ASPE. 2026 Poverty Guidelines
2
Florida Department of Children and Families. Appendix A-7 Family-Related Medicaid Income Limit Chart
3
The Florida Legislature. Florida Code 409.903 – Mandatory Payments for Eligible Persons
4
Florida House of Representatives. Florida Code 409.814 – Eligibility
5
Centers for Medicare & Medicaid Services. HHS Applauds 12-Month Postpartum Expansion in California, Florida, Kentucky, and Oregon
6
Centers for Medicare & Medicaid Services. Florida Medicaid Family Planning Waiver Extension Approval
7
The Florida Legislature. Florida Code 409.904 – Optional Payments for Eligible Persons
8
Social Security Administration. SSI Federal Payment Amounts for 2026
9
Florida Department of Children and Families. Qualified Income Trust Fact Sheet
10
Centers for Medicare & Medicaid Services. Important Facts for State Policymakers – Transfer of Assets in the Medicaid Program
11
Florida Department of Children and Families. Medically Needy Program
12
Medicaid.gov. MAGI-Based Eligibility Verification Plan – Florida
13
Centers for Medicare & Medicaid Services. Medicaid Citizenship Guidelines
14
Medicaid.gov. Overview of Eligibility for Non-Citizens in Medicaid and CHIP
15
HealthCare.gov. Coverage for Lawfully Present Immigrants
16
Florida Senate. Florida Code 409.910 – Responsibility for Payments on Behalf of Medicaid-Eligible Persons When Other Parties Are Liable
17
Florida Department of Children and Families. Appeal Hearings
18
The Florida Legislature. Florida Code 409.9101 – Recovery for Payments Made on Behalf of Medicaid-Eligible Persons