Florida's Medicaid income limit for nursing home and long-term care

How the limit is set

DCF's policy ties the limit to the federal Supplemental Security Income benefit rate: 300 percent of it for one person. Because the federal benefit rate is adjusted each January, Florida's income limit changes every January too. DCF publishes the current figure in Appendix A-9 of its ESS Program Policy Manual, and this page shows the current figure from the firm's own table.

Gross income, not the bank deposit

For nursing home Medicaid, hospice, and the home and community-based waiver, DCF uses gross income to decide eligibility: Social Security before the Medicare premium is withheld, pensions before tax and insurance, and every other regular payment before deductions. A person whose deposits are under the limit can still be over it.

The same limit, different allowances

The income limit is the same in a nursing home, at home, in assisted living, and in PACE. What differs is how much of the person's income they keep after eligibility. In a nursing home, DCF leaves a small personal needs allowance. At home, in the waiver or in PACE, the allowance equals the income limit itself, so a person at home has a patient responsibility only if they qualified through a QIT. In assisted living, the allowance is built from the facility's basic room-and-board rate plus a share of the federal poverty level.

Over the limit

A person whose gross income is over the limit can still qualify if the income above it is deposited into a Qualified Income Trust in the month it is received, every month. Without the trust, the person is not eligible for long-term care Medicaid on income, however little they own.

Assets are a separate test

Meeting the income limit is only one requirement. The asset limit, the transfer rules, and the medical need for the level of care are separate tests, and a QIT does not help with any of them.

Questions

Is Florida an income cap state?

Yes. Florida sets a hard income limit for long-term care Medicaid and uses the Qualified Income Trust for people whose income is over it.

Does the income limit apply to a married couple together?

For a married applicant in a nursing home, DCF does not count income that belongs only to the spouse at home when testing the applicant's income. Our guide for married couples explains how the spouse's income matters afterward.

When does the limit change?

Each January, when the federal SSI benefit rate is adjusted. A person a few dollars under the limit in one year can be over it the next.