Florida Medicaid (SMMC-LTC) Income & Assets Limits for Nursing Homes & Long Term Care

From: www.medicaidplanningassistance.org

Florida Medicaid Long-Term Care Definition

Medicaid is a health care program for low-income individuals of any age. While there are various coverage groups, this page is focused on long-term care Medicaid eligibility for Florida senior residents (aged 65 and over). In addition to care services in nursing homes, adult family care 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. There are three categories of Medicaid long-term care programs for which FL seniors may be eligible.

1) Institutional / Nursing Home Medicaid – An entitlement; anyone who is eligible will receive assistance. Benefits are provided only in nursing homes.

2) Medicaid Waiver / Home and Community Based Services (HCBS) – Not an entitlement; the number of persons who can receive these services is limited and waiting lists 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.

3) Regular Medicaid / Medicaid for Aged and Disabled (MEDS-AD) – An entitlement; 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.

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. While Medicaid is jointly funded by the state and federal government, it is administered by the state. The Agency for Healthcare Administration is the state’s administering agency.

Income & Asset Limits for Florida Eligibility

The three categories of Medicaid long-term care programs have varying financial and medical eligibility criteria. Financial requirements change annually, vary based on marital status, and is further complicated by the fact that Florida offers alternative pathways toward eligibility.

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.

*All of a recipient’s monthly income, minus a monthly Personal Needs Allowance of $160, Medicare premiums, and potentially a Monthly Maintenance Needs Allowance for a non-applicant spouse, must be paid to the nursing home. This is called a Patient Liability.
†Based on one’s living setting, a program beneficiary may not be able to keep monthly income up to this level.

Income Definition & Exceptions

Countable vs. Non-Countable Income

For Medicaid eligibility purposes, nearly any income from any source that a Medicaid applicant receives is counted towards the limit. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Nationally, Holocaust restitution payments are not counted as income. Furthermore, in FL, the VA Aid & Attendance, which is above and beyond the Basic VA Pension, does not count as income.

Treatment of Income for a Couple

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 $2,555 (eff. 7/1/24 – 6/30/25). If a non-applicant’s monthly income is under $2,555, income can be transferred to them 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 $766.60 / month (eff. 7/1/24 – 6/30/25). However, in 2024, a Spousal Income Allowance cannot push a non-applicant’s monthly income over $3,854. This is the Maximum Monthly Maintenance Needs Allowance. More on how this 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. Furthermore, there is no Monthly Maintenance Needs Allowance for the non-applicant spouse. More on how Medicaid counts income.

Asset Definition & Exceptions

Countable vs. Non-Countable Assets

Countable assets are counted towards the income limit and include cash, stocks, bonds, investments, bank accounts (credit union, savings, and checking), 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, and generally one’s primary home. In Florida, IRAs in payout status are also exempt. This means that one’s Required Minimum Distribution (RMD) is being withdrawn.

Treatment of Assets for a Couple
All assets of a married couple are considered jointly owned. This is true regardless of the long-term care Medicaid program for which one is applying and regardless of if one or both spouses are applicants. 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 2024, this Spousal Impoverishment Rule allows the community spouse (the non-applicant spouse) to retain up to $154,140 of the couple’s assets. There is no CSRA for a non-applicant spouse of a Regular Medicaid applicant.

Medicaid’s Look-Back Rule
Florida has a 60-month Medicaid Look-Back Period that immediately precedes one’s Medicaid nursing home or home and community based services application date. During the “look back”, 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 this rule, a Penalty Period of Medicaid ineligibility will ensue. There is no Look-Back Period for Regular Medicaid applicants.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. In 2024, the Gift Tax Rule allows one to gift up to $18,000 per recipient without filing a Gift Tax Return. Gifting under this rule violates Medicaid’s Look-Back Period.

Florida Medicaid Home Exemption Rules

For home exemption, the Medicaid applicant or their spouse must live in the home. If there is no spouse in the home, there is a home equity interest limit of $713,000 (in 2024). Home equity is the value of the home, minus any outstanding debt against it. Equity interest is the amount of the home’s equity that is owned by the applicant. Furthermore, if there is not a spouse in the home, and the Medicaid applicant does not live there, the applicant must have Intent to Return. For Regular Medicaid, there is no home equity interest limit. Other exemptions exist.

While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. Following a long-term care Medicaid beneficiary’s death, Florida’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

Medical / Functional Need Requirements

For Florida long-term care Medicaid, an applicant must have a medical need for such care. For Nursing Home Medicaid and home and community based services to delay the need for institutionalization, a Nursing Facility Level of Care (NFLOC) is required. Furthermore, some benefits may require additional eligibility criteria be met. As an example, for respite care, an inability to be left at home without supervision might be necessary. For long-term care services via the Regular Medicaid program, a functional need with the Activities of Daily Living (ADLs) is required, but a NFLOC is not necessarily required.

Qualifying When Over the Limits

For Florida residents, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.

1) Medically Needy Pathway – Florida has a “Share of Cost” Program, also called a “Spend-Down” Program, for persons who apply for Regular Medicaid / Medicaid for Aged and Disabled (MEDS-AD) 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 2024, the Medically Needy Income Limit (MNIL) 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 MNIL. Once the “spend down” is met, one will be income-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 home and community based services. 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 remaining trust funds 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 this rule was not violated.

4) Medicaid Planning – The majority of persons considering Medicaid are “over-income” and / or “over-asset”, 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. Connect with a Medicaid Planner.

Specific Florida Medicaid Programs

In addition to paying for nursing home care, Florida Medicaid offers the following programs relevant to the elderly that helps them to remain living at home, in adult foster care homes, or in assisted living residences.

1) Florida’s Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program – Former HCBS Medicaid 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 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.

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 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 Florida. For additional information or application assistance, persons can contact their local ACCESS Service Center. Alternatively, persons may call the Florida Department of Children & Families (DCF) Application Center at 1-866-762-2237. The application process may vary based on the program for which one is applying.

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.

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