What Are the Requirements for Florida Medicaid Programs

For people 65 and older or with a disability, Medicaid in Florida can provide valuable medical care. Florida Medicaid provides low-cost or free health coverage for Floridians with low incomes. Medicaid services in Florida are administered by the Agency for Health Care Administration. Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).

We will now look at the different eligibility requirements for Florida Medicaid programs and how Medicaid planning can help you qualify for Medicaid should you need it.

Florida Medicaid: An Overview

The Agency for Health Care Administration manages the Statewide Medicaid Managed Care program in Florida. This program has three parts:

  1. Managed Medical Assistance (MMA): MMA covers doctor visits, emergency care, well-child visits, birthing centers, mental health care, home health and nursing care, hospice, immunizations, prescriptions, and transportation to health services.
  2. Dental: The dental coverage provides dental exams, x-rays, and other dental services for all children and adults.
  3. Long-Term Care (LTC): The LTC program covers long-term services such as assisted living, nursing facility care, companion care, hospice, intermittent and skilled nursing, home-delivered meals, respite care, and certain therapies.

Florida has several LTC programs with varying eligibility criteria:

  • Regular Medicaid
  • Institutional or Nursing Home Medicaid
  • Home and Community-Based Services

We will discuss these further below.

Who Can Apply for Medicaid in Florida?

Florida Medicaid has specific eligibility requirements. First, applicants must be Florida residents, and U.S. citizens, nationals, permanent residents, or legal aliens.

Applicants also must be pregnant, or:

  • Have a disability
  • Be responsible for a child 18 or younger
  • Be responsible for a family member with a disability
  • Be a person 65 or older

Lastly, applicants must meet financial requirements based on their income, assets, and marital status. This is where many people have questions about eligibility and can benefit from Medicaid planning.

Eligibility Requirements for Long-Term Florida Medicaid Programs

Since Medicaid is a needs-based program, recipients cannot have income or assets that exceed certain amounts. Income includes:

  • Wages
  • Alimony payments
  • Pension payments
  • Stock dividends
  • Social security payments

It does not include payments such as COVID-19 stimulus checks, though. Medicaid defines assets as:

  • Cash
  • Investments such as stocks and bonds
  • Real estate other than a person’s primary home
  • Savings and checking accounts

Belongings, automobiles, and financial entities such as irrevocable burial trusts or special needs trusts do not count as assets under Medicaid.

Here are the income and asset requirements for Florida Medicaid LTC programs:

  • Regular Medicaid for Aged and Disabled: This is an entitlement, which means that all eligible persons receive services. These benefits cover at-home care or adult daycare.

To qualify, a single person cannot earn more than $997 a month and own more than $5,000 in assets. Married people, applying either jointly or individually, cannot earn more than $1,343 per month and own more than $6,000 in assets.

  • Institutional or Nursing Home Medicaid: This benefit applies only to nursing homes or institutions, but it’s available to all eligible people as an entitlement.

A single person must earn less than $2,523 per month and own $2,000 or less in assets to qualify. A married couple applying jointly can earn no more than $5,046 per month and cannot own more than $3,000 in assets. If only one spouse applies, the applicant can earn no more than $2,523 a month and cannot own more than $2,000 in assets; their spouse can own no more than $137,400 in assets.

  • Home and Community-Based Services: These benefits apply to home-based services and assisted living facilities, adult daycare, and adult foster care homes.

A single person must earn less than $2,523 per month and own $2,000 or less in assets to qualify. A married couple jointly must earn less than $5,046 per month and own $3,000 or less in assets. A married person applying individually faces the same asset and income limits as Institutional or Nursing Home Medicaid.

How Medicaid Planning Can Help

If you are unfamiliar with applying for Medicaid, this detailed process can seem overwhelming. For some people, Medicaid planning encompasses collecting and preparing documents, while for others, it involves restructuring financial assets so that the applicant’s eligibility remains intact while still having the resources to supplement these benefits or pass them on to loved ones.

You can also establish an entity such as a Pooled Trust or Qualified Income Trust which requires legal and financial expertise to ensure compliance with state law, especially if your family situation involves one spouse who requires long-term care and another who can live independently. These trusts also have specific guidelines for using the money, even after a beneficiary’s death. An estate planning attorney can help you look at all your options.

Talk with an Experienced Miami Attorney about Medicaid Planning Today

At Denise Jomarron Legal Group in Miami, Florida, we help individuals and families design customized plans to ensure protection for their loved ones in case they are incapacitated or pass away. We can also help guide you or your loved one through the Medicaid process. Call us today to schedule your free 20-minute consultation at (305) 402-4494.

Copyright© 2022. Denise Jomarron Legal Group. All rights reserved.

The information in this blog post (“post”) is provided for general informational purposes only and may not reflect the current law in your jurisdiction. No information in this post should be construed as legal advice from the individual author or the law firm, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act or refrain from acting based on any information included in or accessible through this post without seeking the appropriate legal or other professional advice on the particular facts and circumstances at issue from a lawyer licensed in the recipient’s state, country or other appropriate licensing jurisdiction.

Denise Jomarron Legal Group
4300 Biscayne Blvd., Suite 305
Miami, FL 33137-3255
(305) 402-4494

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