Florida Medicaid Long-Term Care Handbook: Eligibility and Limits

To qualify for Florida Medicaid long-term care eligibility in 2026, a single applicant must have no more than $2,000 in countable assets and no more than $2,982 in monthly gross income, be medically assessed as needing nursing-facility-level care, and pass a 60-month review of past asset transfers. Married couples get additional protections for the spouse who is not applying. Applicants whose income runs over the cap are not automatically out — a Qualified Income Trust brings them back within the limit.

Which Program You’re Applying To

Florida runs two long-term care tracks, and the one you fall under changes what happens after approval. The Institutional Care Program (ICP) pays for skilled nursing facility stays. It is an entitlement, so anyone who qualifies gets coverage without waiting.

The Statewide Medicaid Managed Care Long-Term Care Program (SMMC-LTC) pays for care outside a nursing home: assisted living, adult day programs, and services in the recipient’s own home. SMMC-LTC is not an entitlement, and qualified applicants can be placed on a waiting list.¹ Both tracks apply the same financial and medical rules; the difference is where the care happens and whether there’s a wait.

Before either program looks at your finances, you must be a Florida resident with U.S. citizenship or qualifying immigration status.²

Income and Asset Limits for 2026

A single applicant can hold no more than $2,000 in countable assets. Countable means bank accounts, cash, stocks, bonds, and the cash value of life insurance policies. Several assets are excluded from the count: the applicant’s primary home (as long as equity does not exceed $752,000), one vehicle, personal belongings, household furnishings, and irrevocable prepaid burial contracts.

The 2026 monthly income cap is $2,982. That figure applies to gross income from all sources — Social Security, pensions, annuities, everything. Being even a dollar over the cap makes you financially ineligible unless you set up a Qualified Income Trust.

The Qualified Income Trust

A Qualified Income Trust (also called a Miller Trust) is a special bank account that absorbs your income so the amount remaining outside the trust falls under the Medicaid cap. The trust must be irrevocable and can hold only your income, not other assets. When you die, funds left in the trust go to the state up to the amount Medicaid paid on your behalf.³

The Department of Children and Families (DCF) legal office must approve the trust agreement before deposits begin. Once it’s set up, you must deposit income into the trust every single month you need Medicaid. Missing a deposit or under-depositing in any month makes you ineligible for that entire month. Deposits cannot be backdated for a past month or made in advance for a future one.³

If You’re Married

When only one spouse applies, the non-applicant (the “community spouse”) gets substantial financial protection. The rules exist so that impoverishing both spouses to qualify one for care isn’t the price of admission.

The Community Spouse Resource Allowance (CSRA) lets the community spouse keep up to $162,660 of the couple’s combined countable assets in 2026. Anything above that counts toward the applicant’s $2,000 limit.⁴

The Minimum Monthly Maintenance Needs Allowance (MMMNA) protects the community spouse’s income. For 2026, that spouse is guaranteed at least $2,644 per month for living expenses. If their own income falls short, a portion of the applicant’s income can be redirected to them, up to a maximum of $4,067 per month. The exact figure depends on the community spouse’s housing costs and other factors.⁴

The 60-Month Look-Back

Florida reviews five years of financial history before your application date, looking for assets that were given away or sold below fair market value. Any such transfers trigger a penalty period during which you must pay for care out of pocket before Medicaid begins.⁵

The penalty is the total value of disqualifying transfers divided by Florida’s penalty divisor, currently $10,645 per month. That figure roughly reflects the state’s average private-pay nursing home cost. Give a family member $53,225 during the look-back window and the penalty is five months. During those months, Medicaid pays nothing toward your long-term care.

Transfers That Don’t Count Against You

Federal law carves out specific exceptions. These transfers are permitted during the look-back period with no penalty:⁵

Any asset, including the home, transferred to a spouse.
Assets or the home transferred to, or into a trust for, a child who is blind or permanently disabled.
The home transferred to any child under 21.
The home transferred to an adult child who lived there for at least two years before you entered a facility and provided care that delayed institutional placement.
The home transferred to a sibling who already holds an ownership share and lived there for at least one year before you were institutionalized.
Assets placed in a trust established solely for the benefit of a disabled individual under 65.

These exceptions apply only when the specific conditions are met. A transfer to an adult child who didn’t live in the home and provide qualifying care still generates a penalty, even if the intent was to keep the house in the family.

The Medical Side: CARES Assessment

Financial qualification is only half the test. Every applicant must also demonstrate medical need for nursing-facility-level care. The Comprehensive Assessment and Review for Long-Term Care Services (CARES) program handles this determination for both ICP and SMMC-LTC.⁶

A CARES nurse or assessor visits and evaluates your ability to handle Activities of Daily Living: bathing, dressing, eating, transferring (moving from bed to chair, for example), toileting, and continence management. Generally, you need to require hands-on help with at least three of these six to meet the nursing-facility-level-of-care standard. The assessment is free, and it also recommends the least restrictive setting that fits your needs. Someone who qualifies medically but can safely remain at home may be directed to SMMC-LTC rather than a nursing facility.⁶

How to Apply

Applications go through the Florida Department of Children and Families. The fastest route is online through the ACCESS Florida portal. You can also apply in person at a DCF Family Resource Center, through a DCF community partner, or by mailing a paper application.⁷ On the online benefits screen, select the option indicating the need for nursing home or waiver services.

Documentation is heavy. Have ready proof of age, citizenship, and Florida residency, plus at least three consecutive months of statements for every bank account you hold. Also gather life insurance policies, property deeds, vehicle titles, pension statements, Social Security award letters, and records of any asset transfers within the past five years.

Standard Medicaid applications must be processed within 30 days, but long-term care applications can take up to 90 days because of the CARES assessment and financial review.⁷ DCF will send Requests for Information if anything is missing. Respond fast; delays here are where applications stall or get denied.

Florida Medicaid can also cover qualifying medical expenses incurred up to 90 days before the application date, provided you were eligible during that period. This retroactive window matters most when someone enters a nursing home before the paperwork is filed, so don’t hold the application while you chase documents.

What You Pay After Approval

Approval doesn’t mean care is free. Nursing home residents on Medicaid must contribute nearly all of their income toward the cost of care. This contribution is called the patient responsibility.

Start with total gross monthly income. Subtract a personal needs allowance of $160 per month, Medicare Part B and Part D premiums, any supplemental insurance premiums, and any spousal maintenance allowance being paid to the community spouse. Whatever remains goes to the facility each month, and Medicaid covers the difference between that amount and the facility’s actual rate.

If You’re Denied

You can request a fair hearing within 90 days of the date on the Notice of Case Action.⁸ At the hearing, you can be represented by a lawyer, family member, or friend, review your case file beforehand, present witnesses, and argue your case to an impartial hearing officer who was not involved in the original decision.

The state generally must issue a decision within 90 days of receiving the request. If you were already receiving benefits and requested the hearing before the reduction or termination took effect, benefits continue until the decision is final. A hearing that overturns the denial is implemented retroactively to the date of the incorrect action. An unfavorable decision can be appealed to the appropriate District Court of Appeals.⁹

One Thing to Know About What Happens Later

Florida pursues estate recovery after a Medicaid long-term care recipient dies. Every dollar of benefits paid on behalf of someone who was 55 or older when the benefits were received becomes a debt the state files against the estate. Benefits paid before age 55 don’t create a recoverable debt.¹⁰

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. Homestead property protected under Florida’s constitution is also generally shielded. Hardship waivers exist for heirs who lived in the home, for family caretakers who delayed the recipient’s nursing home entry, when recovery would deprive an heir of basic needs, or when selling the property would cost more than it’s worth.¹⁰ Raise a hardship claim as early in probate as possible.

1
Elder Affairs Florida. Statewide Medicaid Managed Care Long-Term Care Program
2
Florida Senate. Florida Statutes 409.902 – Designated Single State Agency; Payment Requirements
3
Florida DCF. Qualified Income Trust Fact Sheet
4
Office of the Law Revision Counsel. 42 USC 1396r-5 – Treatment of Income and Resources for Certain Institutionalized Spouses
5
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
6
Elder Affairs Florida. Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program
7
Florida DCF. Applying for Assistance
8
Florida DCF. Appeal Hearings
9
Medicaid.gov. Understanding Medicaid Fair Hearings
10
The Florida Legislature. Florida Statutes 409.9101 – Medicaid Estate Recovery