A Florida Medicaid waiver is a program that uses Medicaid dollars to pay for long-term care in your home or community instead of a nursing facility. To qualify, you have to need the kind of care a nursing home provides, and you have to meet the state’s income and asset limits — for 2026, generally $2,982 a month in income and $2,000 in countable assets for a single applicant. Florida runs several waivers, each built for a different population, and each with its own application path and waitlist.
What a Waiver Pays For
Federal law normally requires state Medicaid programs to cover nursing home care. Section 1915(c) of the Social Security Act lets states redirect some of that money toward services delivered where the person lives.1Office of the Law Revision Counsel. 42 USC 1396n – Compliance With State Plan and Payment Provisions The services vary by program and by your personal care plan, but they generally include personal care (bathing, dressing, eating), homemaker help, respite for family caregivers, in-home nursing, adult day health care, home modifications like ramps and grab bars, medical equipment, therapies, transportation to appointments, and personal emergency response devices. Every service has to be medically necessary or needed to keep you out of a facility.2Elder Affairs Florida. Statewide Medicaid Managed Care Long-Term Care Program Room and board are not covered under any Florida waiver.
The Three Main Florida Waiver Programs
Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC)
This is the largest waiver program for seniors and adults with physical disabilities. The Florida Legislature created it in 2011, and it enrolls participants into a managed care plan that coordinates their home and community-based services.2Elder Affairs Florida. Statewide Medicaid Managed Care Long-Term Care Program Eligible groups include people 65 and older, adults 18 to 64 with physical disabilities or brain injuries, people living with HIV/AIDS, and people who are medically fragile.3Medicaid.gov. Florida Waiver Factsheet Once enrolled, you pick a plan available in your region, and the plan assigns a case manager who builds your care plan and arranges services.
iBudget Florida
iBudget is Florida’s waiver for people with developmental disabilities, run by the Agency for Persons with Disabilities (APD).4Agency for Persons with Disabilities. iBudget Florida Instead of a managed care plan, each participant receives an individualized budget to spend on approved services. Qualifying conditions include intellectual disability, autism, cerebral palsy, Down syndrome, spina bifida, and Prader-Willi syndrome, and the program is open to people age 3 and older.5Agency for Health Care Administration. Developmental Disabilities Individual Budgeting (iBudget) Waiver To apply, call APD at 1-866-273-2273.
Comprehensive IDD Managed Care Pilot
Florida also operates a managed care pilot for adults 18 and older with autism, intellectual disabilities, or other developmental disabilities who need an institutional level of care. It uses the managed care model but is tailored to the developmental disabilities population, covering services like residential habilitation, supported employment, behavior analysis, and supported living coaching.3Medicaid.gov. Florida Waiver Factsheet
Who Qualifies
The Medical Test
Every Florida waiver requires that you need a “nursing facility level of care.” You don’t have to actually be in a facility. Your condition has to be serious enough that you would need one without the waiver services. The state’s Comprehensive Assessment and Review for Long-Term Care Services (CARES) program makes that call, looking at whether you need daily nursing supervision or medical care, whether you’re at imminent risk of placement, and how well you can perform daily activities like bathing, dressing, eating, and moving around.6Florida Legislature. Florida Statutes 409.985 – Comprehensive Assessment and Review for Long-Term Care Services For iBudget and the IDD pilot, the standard is the level of care for an intermediate care facility for individuals with intellectual disabilities (ICF/IID) instead.3Medicaid.gov. Florida Waiver Factsheet
Income and Assets in 2026
For a single applicant in 2026:
- Monthly income cap: $2,982, which is 300 percent of the federal SSI benefit rate of $994. This is gross income, before any deductions.7Social Security Administration. SSI Federal Payment Amounts for 2026
- Countable asset limit: $2,000. For a married couple with both spouses applying, the combined limit is $3,000.
- Home equity: your primary residence is generally exempt as long as equity does not exceed $752,000.
Countable assets include bank accounts, stocks, bonds, and investment accounts. Exempt items include the primary home within the equity limit, one vehicle, personal belongings, prepaid burial plans, and small life insurance policies.
If Only One Spouse Needs Care
When just one spouse applies, the other spouse’s income generally does not count toward the applicant’s limit. Federal spousal impoverishment rules also protect the community spouse’s assets. In 2026, the non-applicant spouse can keep up to $162,660 under the Community Spouse Resource Allowance.8Centers for Medicare and Medicaid Services. January 2026 SSI and Spousal Impoverishment Standards
If Your Income Is Over the Cap
Income above $2,982 a month does not automatically disqualify you. Florida lets applicants set up a Qualified Income Trust (QIT), also called a Miller Trust. Each month, you deposit enough income into the trust that the income remaining outside it falls under the limit.9Florida Department of Children and Families. Qualified Income Trust Fact Sheet The trust must be irrevocable and must name Florida as the remainder beneficiary up to the total Medicaid benefits paid for you. The structure itself is not complex, but the paperwork has to be correct and the monthly deposits have to happen on time, which is why many families use an elder law attorney for this piece.
Applying, and Why Approval Isn’t the Same as Services
For SMMC-LTC, start with the Elder Helpline at 1-800-963-5337. That call routes you to a local Aging and Disability Resource Center, which runs the initial screening and assigns a priority score based on the urgency of your needs. From there, you’re referred for the full CARES assessment.10Florida Agency for Health Care Administration. Statewide Medicaid Managed Care Long-Term Care Program – Screening
Being approved does not mean you start receiving services. SMMC-LTC has a limited number of slots, and when they’re full a waitlist forms. Position on that list is determined by priority score, not by how long you’ve been waiting, so someone in a more urgent situation can move ahead of someone who applied earlier. People scored as low priority aren’t put on the waitlist at all and are directed to other community resources.10Florida Agency for Health Care Administration. Statewide Medicaid Managed Care Long-Term Care Program – Screening iBudget runs its own separate APD waitlist, and waits for developmental disability services have historically run years long.
Two Things That Catch Families Off Guard
The 60-Month Look-Back
When you apply, the state reviews your financial transactions for the previous 60 months. The point is to catch asset transfers made to appear financially eligible. Federal law requires this review for everyone seeking long-term care coverage.11Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets If the state finds transfers for less than fair market value during that window, it imposes a penalty period calculated by dividing the uncompensated value by the average monthly cost of nursing facility care in the state. A $100,000 gift against a $10,000 average monthly cost works out to roughly 10 months of ineligibility.
Here is where people get caught: the penalty period starts on the date you would otherwise become eligible, not on the date of the transfer. Give assets away four years ago, apply now, and the clock begins when you qualify, leaving you without coverage for months at exactly the moment you need it. This is the most common reason families consult an elder law attorney well before they expect to need the waiver.
Estate Recovery After Death
Florida law creates a debt against a Medicaid recipient’s estate for all medical assistance paid on their behalf after age 55. When a waiver recipient dies, the state can seek repayment from what remains in the estate, up to the amount Medicaid actually paid.12Florida Legislature. Florida Statutes 409.9101 – Medicaid Estate Recovery Federal law requires every state to operate a recovery program for recipients 55 and older who received nursing facility services or waiver services.13Medicaid.gov. Estate Recovery
Florida cannot pursue recovery if the recipient leaves behind a spouse, a child under 21, or a child of any age who is blind or permanently and totally disabled. The state also cannot recover against property exempt from creditor claims under Florida law, which includes protected homestead property. An heir or personal representative can request a hardship waiver, though wanting to keep an inheritance isn’t by itself a hardship.12Florida Legislature. Florida Statutes 409.9101 – Medicaid Estate Recovery
If You’re Denied
You have the right to request an administrative fair hearing through the Florida Department of Children and Families if your application is denied or your benefits are reduced. The deadline is 90 days from the Notice of Case Action.14Florida Department of Children and Families. Appeal Hearings Most hearings happen by phone, though you can ask for one in person. If the Final Order goes against you, you can appeal to the appropriate District Court of Appeal within the time limit in the order. File the hearing request first, inside the 90 days, and prepare the rest of your case from there.