Many families are surprised to learn that it is not too late to qualify for Medicaid—even if your loved one is already in a nursing home. Florida’s Medicaid program can help cover the significant cost of long-term nursing care, which often exceeds $9,000 per month. With careful planning and timely action, it is possible to protect assets, preserve income for a spouse, and still obtain Medicaid coverage.
If your loved one is already in a nursing home, don’t wait to find out what options are available. Call Flammia Elder Law Firm at (407) 478-8700 to speak with a Florida Medicaid planning attorney. We can help you understand your eligibility, protect your assets, and seek to secure the coverage your family needs.
What Does Medicaid Pay for in a Nursing Home?
For Florida residents who qualify, Medicaid will cover the room and board at the nursing home and the Medicare Part B premium. You can also deduct drug costs as an unreimbursed medical expense.
Covered services usually include room and board, 24-hour nursing care, rehabilitation therapies, meals, medications, and essential personal care supplies. Some optional or upgraded amenities—such as private rooms, special meal requests, or salon services—may require an additional out-of-pocket payment.
What Are the Eligibility Requirements for Florida Nursing Home Medicaid?
To qualify for nursing home coverage, an applicant must meet both medical and financial criteria.
Medical eligibility is determined through Florida’s CARES (Comprehensive Assessment and Review for Long-Term Care Services) program. A healthcare provider completes the required AHCA Form 5000-3008, and the CARES team confirms that the applicant requires a nursing facility level of care.
Financial eligibility is based on both income and assets. In 2025, the individual income cap is $2,901 per month, but if income exceeds this amount, a Qualified Income Trust (QIT), also known as a Miller Trust, can often be used to bring countable income below the limit. Applicants are allowed to keep a $160 monthly personal needs allowance, and spouses who remain at home may retain up to $157,920 in countable assets, along with exempt property such as the family home and one vehicle. For spouses who have more than $157,920, it is still possible to get their spouse nursing home benefits by using spousal refusal.
For single applicants, the asset limit is $2,000 in countable resources. Exempt assets typically include the primary residence (up to the federal home-equity limit of $730,000), personal belongings, household furnishings, one car, and prepaid burial plans. Understanding which assets are countable versus exempt, and how to properly structure them, can make a significant difference in qualifying for Medicaid without losing your life savings.
What If My Loved One’s Income or Assets Are Too High?
Many families assume that having income or savings above the limits automatically disqualifies them, but that is not always the case. With proper Medicaid planning, assets and income can often be legally structured to meet eligibility rules without spending everything on care.
The language in your loved one’s durable power of attorney becomes of vital importance to ensure their agent has Medicaid planning powers.
A Qualified Income Trust can resolve over-income issues, while Medicaid planning can solve situations where an applicant is over assets. These actions must be documented and timed correctly, so professional guidance is highly recommended.
If your loved one’s income or assets are above Medicaid limits, don’t assume help is out of reach. Call Flammia Elder Law Firm at (407) 478-8700 to discuss your options. Our dedicated team can guide you through Florida’s Medicaid rules, help you protect what you’ve worked for, and create a plan that meets eligibility requirements without unnecessary financial loss.
Can Assets Be Protected If My Loved One Is Already in a Nursing Home?
Yes. Even if your loved one has already entered a nursing home, there are still lawful and effective ways to protect assets and qualify for Medicaid. The key is taking prompt, informed action. With the right legal strategy, families can often preserve a portion of savings, safeguard income for a spouse, and ensure that future financial needs are met.
Florida’s Medicaid rules provide important protections for the community spouse, the husband or wife who remains at home. The law allows the community spouse to retain a fair share of income and assets to maintain financial stability, pay household expenses, and continue living independently. This can include retaining the family home, a vehicle, and a portion of liquid savings.
Even for single applicants, certain assets are considered exempt. These often include the primary residence (within value limits), personal belongings, household furnishings, and prepaid burial arrangements. A Medicaid planning attorney can help identify which assets are protected and how to convert countable resources into exempt ones through strategies such as home improvements, debt repayment, or setting aside funds for burial expenses.
Families should avoid transferring or gifting assets in an effort to “spend down” without guidance. Florida’s five-year lookback period means that uncompensated transfers can lead to a Medicaid penalty, delaying coverage and increasing private-pay costs. Before making any financial moves, it is essential to consult with a Medicaid planning attorney who can guide you through the process, protect your eligibility, and help you make the most of the planning opportunities that still exist.
What Is the Medicaid Lookback Period?
The Medicaid lookback period is a review window used by the Florida Department of Children and Families (DCF) to determine whether any assets were transferred or gifted before applying for Medicaid. In Florida, this period covers the five years (60 months) leading up to the application date. During this review, Medicaid examines all financial transactions to ensure that assets were not given away or sold for less than fair market value in an attempt to meet eligibility requirements.
If DCF finds that assets were transferred during the lookback period without proper compensation, it may impose a penalty period. This penalty delays the start of Medicaid coverage for nursing home care until the value of the transferred assets has been “repaid” through time. The length of the penalty is calculated by dividing the total value of the transferred assets by Florida’s average monthly cost of nursing home care, also known as the divisor amount, which is adjusted annually.
The lookback period does not prevent all forms of planning. Certain transfers are considered exempt, such as those made to a spouse, a child with a disability, or into a properly structured trust. Additionally, there are legal strategies that allow families to protect assets even if some transfers have already occurred.
Because even small or unintended transactions can trigger a penalty, it is important to work with an experienced Medicaid planning attorney before submitting an application. With proper guidance, families can often reduce or eliminate penalties and secure eligibility sooner, protecting their loved one’s access to care while preserving assets for future needs.
How Does Qualifying for Medicaid Differ if You’re Already in a Nursing Home?
The process for qualifying for Medicaid in Florida depends on where the person is receiving care. When someone is already in a nursing home, they apply under the Institutional Care Program (ICP), which is an entitlement benefit. This means that if they meet all eligibility requirements, coverage begins without a waiting list. Once approved, Medicaid pays the nursing home directly for the covered cost of care, and the resident contributes most of their income as a patient responsibility while keeping a small personal needs allowance.
In contrast, individuals who are still living at home or in an assisted living facility apply through the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program. This program is a waiver, which means participation is limited and often involves a waiting list. Although both programs have the same basic income and asset limits, they work very differently in practice.
Under the waiver program, Medicaid helps pay for approved home and community-based services, such as personal care, transportation, and limited assistance in assisted living. However, room and board costs at assisted living facilities are not covered. Applicants remain responsible for those charges until institutional care is needed or funding becomes available.
The medical qualification process is similar for both programs. Florida’s CARES assessment determines whether the applicant meets the nursing home level of care standard required for Medicaid long-term care benefits. The difference lies in how services are delivered and how payments are handled once eligibility is established.
Because each program has unique rules and timelines, families should carefully evaluate which option best fits their loved one’s needs and financial situation. You can learn more about available programs and planning strategies by visiting our Medicaid Planning Resource Center or by calling Flammia Elder Law Firm at (407) 478-8700 for personalized guidance.
When Does Medicaid Coverage Begin?
In Florida, Medicaid coverage typically begins on the first day of the month in which the application is filed, once all requirements are met. Unlike in some other states, Florida generally does not offer three months of retroactive coverage for adults, so starting the process promptly is important to avoid paying unnecessary private costs.
How Can a Medicaid Planning Attorney Help?
Applying for Medicaid and planning for long-term care can be complicated, especially when one spouse remains at home or when the applicant’s finances exceed the limits. A Florida elder law attorney who focuses on Medicaid planning can:
- Confirm nursing home level-of-care eligibility
- Draft and administer a Qualified Income Trust
- Structure lawful spend-down and asset-protection strategies
- Prepare and submit the Medicaid application to avoid costly delays or denials
- Ensure that the community spouse retains the maximum income and assets allowed
Working with an experienced Medicaid planning attorney can significantly reduce stress and financial risk during an already difficult time.
Schedule A Consultation with an Experienced Medicaid Planning Attorney
If your loved one is already in a nursing home or may soon need long-term care, it is not too late to act. Medicaid can provide critical financial relief and peace of mind. The sooner you begin the planning process, the more options you have to protect your assets and secure coverage.
Contact Flammia Elder Law Firm at (407) 478-8700 to schedule a consultation. Our Medicaid planning team helps Florida families navigate the Medicaid process with compassion and clarity.
Frequently Asked Questions About Florida Medicaid
How much does Medicaid pay for nursing home care in Florida?
Medicaid pays for the room and board and the Medicare Part B. You can also deduct drug costs as an unreimbursed medical expense.
Can Medicaid help pay for assisted living or in-home care instead?
Yes. Florida’s Long-Term Care Managed Care program can help pay for assisted living or home-based services, though availability may depend on medical need and regional waitlists.
Will Medicaid take my home?
Florida’s homestead property is generally exempt while the Medicaid recipient or a spouse lives there. After death, as long as the homestead is left to a lawful heir, the homestead then can pass on to the surviving spouse, children or other family members.
How far back does Medicaid look at asset transfers?
Florida follows a five-year lookback period. Uncompensated transfers within that time can result in a penalty period during which Medicaid will not pay for care.
Do all nursing homes accept Medicaid?
No. Only Medicaid-certified facilities can receive Medicaid payments. You can search for certified facilities using Medicare’s Care Compare tool.
