Florida Medicaid Long Term Care Programs, Benefits & Eligibility Requirements

Summary
Medicaid’s rules, benefits and name can all vary by state. This article focuses on Florida Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, Statewide Medicaid Managed Care (SMCC) Long-Term Care (LTC) and Medicaid for Aged and Disabled (MEDS-AD). This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Mar 27, 2024

Florida Medicaid Long Term Care Programs Nursing Home Care Care at Home via SMMC LTC Care at Home via MEDS-AD Medicaid Eligibility Criteria Nursing Homes SMMC LTC MEDS-AD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

Florida Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

Florida Nursing Home Medicaid will cover the cost of long-term care in a nursing home for financially limited Florida seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

Florida Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover nursing home expenses. They are allowed to keep a “personal needs allowance” (PNA) of $160/month (as of July 1, 2023), which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are “dual eligible,” and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid recipients.

Florida Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

Statewide Medicaid Managed Care Long-Term Care Waiver Program

Florida’s Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Waiver Program will pay for long-term care services and supports that help Florida Medicaid beneficiaries who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. Living “in the community” can mean living in their home, the home of a loved one, an adult family care home or an assisted living residence. While the SMMC LTC Program covers some long-term care benefits in those settings, it will not cover room and board costs.

SMMC LTC Program benefits include adult day care, in-home skilled nursing care, medical equipment, transportation and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits are made available depending on each individual’s needs and circumstances. Benefits will be delivered through a single plan from a managed care organization (MCO) and its network of healthcare providers. However, some of the non-medical benefits, like personal care and housekeeping, can be consumer-directed. This means the SMMC LTC program participant can hire providers of their choice for those benefits, including spouses and adult children.

Unlike Nursing Home Medicaid, Florida’s SMMC LTC Program is not an entitlement. Remember, entitlement means guaranteed by law. Instead, the SMCC LTC Program has a large but limited number of enrollment spots (107,875 as of 2023), and once those spots are full additional applicants will be placed on a waitlist. The SMMC LTC waitlist is managed by the Department of Elder Affairs (DOEA) and the Aging and Disability Resource Centers. Each month DOEA releases individuals from the waitlist based on their medical needs and frailty.

The SMMC Program has two other parts that are not specifically relevant to seniors – Managed Medical Assistance (MMA) and Dental. Those programs are not covered in this article.

The SMMC LTC Program replaced all previous Home and Community Based Service (HCBS) Waivers in Florida.

Medicaid for Aged and Disabled (MEDS-AD)

Florida’s Medicaid for Aged and Disabled (MEDS-AD) provides healthcare coverage and long-term care services and supports to financially limited Florida residents who are aged (65 and older) or disabled and live in the community. MEDS-AD can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for low-income people of all ages. MEDS-AD is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive the benefits without any wait.

1. MEDS-AD Long Term Care Benefits
Eligible Florida seniors who show a medical need for long-term care goods and services can receive those goods and services through MEDS-AD. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). MEDS-AD recipients qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its benefits immediately available for anyone who qualifies. Instead, Florida seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Program of All-Inclusive Care for the Elderly (PACE)
Florida residents who are age 55 or older and have MEDS-AD can cover their medical, social service and long-term care needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. Florida’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and they will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. Florida’s PACE programs are located in Fort Meyers (Hope PACE), Hialeah (Mount Sinai Eldercare), West Palm Beach (Palm Beach PACE), Jacksonville (the PACE Place), Miami (Florida PACE Centers, Inc.), Tampa (Empath LIFE) and Pinellas Park (Suncoast PACE, Inc.). To learn more about PACE, click here.

Eligibility Criteria For Florida Medicaid Long Term Care Programs

To be eligible for Florida Medicaid, a person has to meet certain financial requirements and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid, and what program they are applying for – Nursing Home Medicaid, Statewide Medicaid Managed Care (SMCC) Long-Term Care (LTC) or Medicaid for Aged and Disabled (MEDS-AD).

Just For You: The easiest way to find the most current Florida Medicaid eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

Florida Nursing Home Medicaid Eligibility Criteria

Financial Requirements
Florida residents have to meet an asset limit and an income limit in order to be financially eligible for Nursing Home Medicaid. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Florida Nursing Home Medicaid for a single applicant is $2,829/ month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, Florida Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $160/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy spouses who are not covered by Medicaid.

For married applicants with both spouses applying, the 2024 asset limit for Florida Nursing Home is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for Florida Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Florida has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Florida Medicaid’s Nursing Home Medicaid is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with nursing homes. To determine level of care need for Medicaid purposes, the state will evaluate an applicant’s ability to to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.). Cognitive abilities and behavioral issues are also taken into consideration. To make these evaluations, Florida uses its Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program, and the AHCA 5000-3008 Form, “Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form.”

Florida’s Statewide Medicaid Managed Care Long-Term Care Eligibility Criteria

Financial Requirements
Florida residents have to meet an asset limit and an income limit and in order to be financially eligible for the Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program. For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for Florida’s SMMC LTC Program for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for the SMMC LTC Program is a combined $3,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying for the SMMC LTC Program, the 2024 asset limit is $2,000 for the applicant spouse and $154,140 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for SMMC LTC applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, Florida has a Look-Back Period of five years. This means the state will look back into the previous five years of the SMMC LTC applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Florida’s SMMC LTC Program is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with nursing homes. To determine level of care need for Medicaid purposes, the state will evaluate an applicant’s ability to to perform the Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and the Instrumental Activities of Daily Living (such as shopping, cooking, cleaning, etc.). Cognitive abilities and behavioral issues are also taken into consideration. To make these evaluations, Florida uses its Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program, and the AHCA 5000-3008 Form, “Medical Certification for Medicaid Long-Term Care Services and Patient Transfer Form.”

Florida’s Medicaid for Aged and Disabled Eligibility Criteria

Financial Requirements
Florida residents have to meet an asset limit and an income limit in order to be financially eligible for Medicaid for Aged and Disabled (MEDS-AD). The asset limit for a single applicant from April 2024 to March 2025 is $5,000, which means they must have $5,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for MEDS-AD for a single applicant from April 2024 to March 2025 is $1,104/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants from April 2024 to March 2025, the asset limit for MEDS-AD is a combined $6,000, and the income limit is a combined $1,492/month. These limits are used for both married couples with both spouses applying for MEDS-AD and married couples with only one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for Florida MEDS-AD applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While Florida has a Look-Back Period period of five years for Nursing Home Medicaid and Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period for MEDS-AD applicants. However, MEDS-AD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or SMMC LTC, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through Florida’s MEDS-AD is being aged (65 and over) or disabled. For MEDS-AD applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How Florida Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – MEDS-AD applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

Florida Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in Florida and how you can protect your home from it, click here.

Applying For Florida Medicaid Long Term Care Programs

The first step in applying for a Florida Medicaid Long Term Care program is deciding which of the three programs discussed above you or your loved one want to apply for – Nursing Home Medicaid, Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) or Medicaid for Aged and Disabled (MEDS-AD).

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that program. Applying for Florida Medicaid when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Florida Medicaid applicant. These documents will be needed for the official Florida Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, individuals can apply through the state’s ACCESS website. For help with this process, individuals can call the ACCESS Customer Call Center at 866-762-2237, or they can contact their local ACCESS Service Center.

Applying to the Statewide Medicaid Managed Care Program
To apply for Florida’s Statewide Medicaid Managed Care (SMMC) Program, individuals first need to be on Florida Medicaid. If they are not, they can apply through the state’s ACCESS website. Once an individual is enrolled in Medicaid, the next step in applying for the SMMC Program is contacting their local Aging and Disability Resource Center for a screening over the phone. To find your local Aging and Disability Resource center, go to this Department of Elder Affairs webpage. One can also call the Elder Helpline at 1-800-963-5337 for assistance with this application process.

Once the application is received, it will usually take 45-90 days to be reviewed and approved or denied by the state. It’s also possible applications that are missing information or have mistakes will be returned.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a Florida Medicaid Nursing Home

After being approved for Nursing Home Medicaid through Florida Medicaid, seniors need to choose which Medicaid-accepting nursing home best meets their needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do might not have any available spaces. Finding the right nursing home can be a chore, especially if you are looking in a specific location.

There are roughly 700 licensed nursing homes in Florida with about 84,500 beds, according to data from Florida’s Agency for Health Care Administration. They are spread throughout the state with clusters around the major population centers. There are about 110 nursing homes that accept Medicaid between Miami and West Palm Beach in the southeast corner of the state. The Tampa Bay area has almost 100 nursing homes that take Medicaid between the cities of St. Petersburg, Tampa and Clearwater. The choices are more limited on the southern tip of the Gulf Coast side, with about 20 nursing homes in Fort Meyers that take Medicaid and around a dozen more in Naples. The choices are also fewer in the panhandle, with roughly 20 nursing homes in Pensacola, 10 in Tallahassee and five in Panama City.

TOOLS: To help them find a nursing home, Florida residents can use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information about more than 15,000 nursing homes across the country. They can also use a Florida-specific facility finder by clicking here.

Once you’ve found nursing homes in your area that accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by overall rating, health inspections, staffing and quality measures, which can be a helpful place to start. The healthcare professionals who work with you are also a great source of information. And you can find out more about Florida nursing homes by contacting your local Area Agency on Aging.

After doing your research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, such as: Does the residence offer social activities? Does it provide transportation social? Are there private spaces for when you have visitors? What are the meals like? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

According to CMS data, Florida nursing homes averaged 18.2 health deficiencies from 2019-2022, which is less than the national average of 25.7. Florida nursing homes also averaged 7.9 fire deficiencies, which is also less than the nationwide average of 13.5 And only 2.5% of residents in Florida nursing homes reported depressive symptoms, which is much better than the national average of 8.1%.