A Florida Medicaid waiver pays for long-term care services in your home or community instead of a nursing facility. The state runs two main programs: the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) waiver for older adults and adults with disabilities, and the iBudget waiver for people with developmental disabilities. Both have strict eligibility rules and both have waitlists. For the SMMC LTC program in 2026, you generally need monthly income below $2,982 and countable assets under $2,000 to qualify.
What the SMMC LTC Waiver Pays For
The Agency for Health Care Administration (AHCA) oversees the SMMC LTC program, but once you qualify you pick a managed care plan, and that plan assigns a care coordinator who builds your service package.1Elder Affairs Florida. Statewide Medicaid Managed Care Long-Term Care Program The waiver is designed for people who need nursing-facility-level care but want to receive it at home.
Covered services include:
- Personal care assistance with bathing, dressing, eating, and other daily activities
- Skilled nursing, including medication management and wound care
- Adult day health care with activities, meals, and medical monitoring
- Respite care to give family caregivers a break
- Home modifications such as ramps, grab bars, and bathroom adaptations
- Non-emergency medical transportation
The specific hours and services you receive come from your care plan. Managed care organizations control authorization, so disputes over service levels do happen, and you have appeal rights if your plan cuts back on what you need.
Financial Eligibility
You have to clear two separate tests to qualify: a financial test and a functional test. The financial side has an income limit and an asset limit, and the rules shift when the applicant is married.
Income Limit
Florida caps monthly income for the SMMC LTC waiver at 300% of the federal SSI benefit rate. In 2026, the SSI benefit for an individual is $994 per month, which puts the waiver’s income ceiling at $2,982 per month.2Social Security Administration. SSI Federal Payment Amounts for 2026 Social Security, pensions, annuities, and most other regular payments count. The figure adjusts each year with cost-of-living increases.
Income above the cap doesn’t automatically disqualify you. Florida allows a Qualified Income Trust, often called a Miller Trust: you set up an irrevocable trust and deposit the excess income into it each month, and the amount in the trust stops counting toward eligibility. The trust has to be funded every single month, and after you die any remaining funds go to the state to reimburse Medicaid. Setting one up usually requires an attorney who knows Florida Medicaid rules.
Asset Limit
A single applicant can hold no more than $2,000 in countable assets — bank accounts, investment accounts, cash, and most other financial resources. A few things don’t count:
- Your primary home, up to $752,000 in equity. Above that, you won’t qualify unless a spouse or dependent relative lives there.3Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
- One vehicle, typically regardless of value
- Personal belongings and household goods
- An irrevocable prepaid burial plan
The $2,000 line is easy to trip over. What matters is your balance on the day Medicaid reviews your case, so a Social Security deposit that hasn’t yet been spent on bills can push you over. Applicants often time their spending around verification dates.
If You’re Married
When only one spouse needs waiver services, federal spousal impoverishment rules keep the healthy spouse from being wiped out. The Community Spouse Resource Allowance lets the non-applicant spouse keep a share of the couple’s combined assets. In 2026 that allowance ranges from a floor of $32,532 to a ceiling of $162,660, depending on total countable resources.3Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards Anything above that generally has to be spent down before the applicant qualifies.
Income is protected too. Through June 2026, the federal Minimum Monthly Maintenance Needs Allowance floor is $2,643.75 per month. If the non-applicant spouse’s own income falls below that, part of the applicant’s income can be redirected to make up the shortfall.
Functional Eligibility: The CARES Assessment
Meeting the money rules isn’t enough. You also have to need nursing-facility-level care. Florida’s Comprehensive Assessment and Review for Long-Term Care Services (CARES) unit handles this evaluation.4Agency for Health Care Administration. CARES Assessment of Long-Term Care Needs A nurse or social worker reviews your ability to perform daily activities like bathing, dressing, eating, transferring in and out of bed, and using the bathroom, and looks at cognitive function for conditions like dementia.
The assessor weighs the overall picture: how many activities you need help with, how much help, and whether cognitive impairment adds safety risks on top of physical limits. Someone who can technically dress themselves but wanders off due to dementia may qualify as readily as someone with severe physical limitations. The core question is whether you’d end up in a nursing facility without the waiver.
How to Apply
Two agencies and two determinations run on parallel tracks. Start by contacting the Florida Department of Children and Families (DCF) or your local Area Agency on Aging to trigger the CARES assessment. At the same time, submit a Medicaid application with financial documentation to DCF: bank statements, proof of income from all sources, property deeds, vehicle titles, and insurance policies.5Agency for Health Care Administration. Long-Term Care Program DCF decides financial eligibility. CARES decides functional eligibility. Both have to come back positive.
The Waitlist
Qualifying doesn’t mean services start right away. Florida keeps a waitlist, sometimes called a priority or interest list, and your position depends on your assessed level of need. People at the highest risk of nursing home placement move up faster. The list length rises and falls with state funding and turnover in the program, and some applicants wait months. You don’t receive waiver services while you wait, which is why applying before a crisis hits matters.
The Five-Year Look-Back
Florida reviews your financial transactions for the 60 months before your application date.6Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets Gifts, below-market sales, and other transfers for less than fair value during that window trigger a penalty period: a stretch of time when you’re otherwise eligible but barred from receiving waiver services. The penalty is calculated by dividing the value of what you transferred by the average monthly cost of nursing home care in Florida. A $100,000 gift three years before applying could lock you out for many months, and the penalty doesn’t start running until you’d otherwise qualify.
There are exceptions. You can transfer your home to a spouse, a child under 21, or a blind or disabled child of any age without penalty. You can also transfer it to an adult child who lived with you for at least two years before your institutionalization and provided care that delayed your need for facility placement, the so-called caregiver child exception. Documentation is strict: a physician’s statement, proof of residence, and evidence the care actually delayed placement. If you’re thinking about any significant transfers, either do them well outside the five-year window or talk to an elder law attorney first.
Estate Recovery After Death
When a Medicaid recipient dies, federal law requires Florida to seek reimbursement from the estate for long-term care costs the program paid.7Medicaid.gov. Estate Recovery This applies to anyone 55 or older who received nursing facility services, home and community-based waiver services, or related hospital and prescription drug benefits. In most cases, the asset in play is the family home: exempt during the recipient’s lifetime, subject to a Medicaid claim after death.
Recovery can’t happen while a surviving spouse is alive, or while a surviving child under 21 or a blind or disabled child of any age is living. Florida also has to offer hardship waivers when recovery would create undue financial hardship for surviving family. If estate recovery is likely to affect your family, raising it with an elder law attorney while the recipient is still alive opens more options than waiting.
If You’re Denied or Your Services Are Cut
Denials and service reductions can be appealed in two stages. First, you appeal to your managed care plan, which reviews its own decision and sends you a written Notice of Plan Appeal Resolution. If the plan upholds its decision, you can request a Medicaid Fair Hearing through AHCA.8Agency for Health Care Administration. Medicaid Fair Hearings
You can ask for a Fair Hearing by calling the Medicaid Helpline at 1-877-254-1055, or in writing by email, fax, or mail to AHCA’s Medicaid Hearing Unit in Tallahassee. Include the recipient’s name and Medicaid ID number, a description of what was denied or reduced, and copies of any notices. Fair Hearings go before an independent hearing officer, and outcomes sometimes differ from the plan’s internal review.
The iBudget Waiver for Developmental Disabilities
The iBudget Florida Waiver is a separate program, run by the Agency for Persons with Disabilities (APD) rather than AHCA.9Agency for Persons with Disabilities. iBudget Florida It provides home and community-based services for people with developmental disabilities. Qualifying conditions include:10Agency for Persons with Disabilities. iBudget Florida HCBS Waiver Eligibility Work Sheet
- Intellectual disabilities
- Autism spectrum disorder
- Cerebral palsy
- Down syndrome
- Spina bifida
- Prader-Willi syndrome
- Phelan-McDermid syndrome
- Children ages 3 through 5 at high risk of a developmental disability
Each recipient gets a personalized annual budget based on assessed needs and existing supports, and services are purchased within that budget. The waitlist is the bigger obstacle. As of December 2025, more than 17,400 people were on the preenrollment list, and waits of several years are not unusual. Families should apply to APD as early as possible, because time on the waitlist is the single biggest factor in eventually receiving services.