Florida Medicaid for seniors and long-term care

Last verified: June 2026

$2,000

Asset limit (individual)

$2,829/mo

Income cap → Miller Trust

SMMC-LTC

Managed LTC program

CARES req.

Assessment before LTC enrollment

LTC Medicaid rules are complex — consult an elder law attorney licensed in Florida

Florida long-term care Medicaid has strict asset and income rules, lookback periods, and estate recovery. Miller Trusts (Qualified Income Trusts) are required when income exceeds the income cap. For situation-specific guidance, consult a Florida-licensed elder law attorney or contact your local SHINE counselor (1-800-963-5337) for free general information.

Florida was a national pioneer in managed long-term care

Florida launched its Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) program in 2013 — making it one of the first states to move Medicaid long-term care services into a managed care model at scale. Most other states still use fee-for-service or 1915(c) waiver structures. In Florida, LTC services are delivered by contracted LTC managed care plans, not directly by the state.

How Florida's long-term care Medicaid works

Florida delivers Medicaid long-term care services through the SMMC-LTC program, administered by AHCA. Enrollees choose or are assigned to an LTC managed care plan. Each plan is responsible for coordinating the full range of LTC services — nursing facility care, home health, personal care, and community-based alternatives.

There is a waitlist for SMMC-LTC. The waitlist is managed by local Aging and Disability Resource Centers (ADRCs). Contact your ADRC to get on the waitlist as early as possible — call the statewide Elder Helpline at 1-800-963-5337 (1-800-96-ELDER) to be connected to your local ADRC.

While waiting for SMMC-LTC enrollment, some services may be available through the fee-for-service Medicaid program or through community programs administered by the Department of Elder Affairs (DOEA).

Who qualifies for SMMC-LTC?

Three conditions must all be met, per Florida Department of Elder Affairs eligibility rules:

Age and disability: age 65 or older, OR age 18 or older with a qualifying disability
Medicaid eligibility: financially eligible for Medicaid under SSI-related rules (income and asset limits apply)
Level of care: assessed by the CARES unit as needing nursing home level of care, meeting at least one established clinical criterion

The CARES assessment (Comprehensive Assessment and Review for Long-Term Care Services) is conducted by the Department of Elder Affairs. CARES determines whether an individual meets the clinical criteria for nursing home level of care — a threshold required before SMMC-LTC enrollment can proceed. The assessment looks at functional limitations, cognitive status, and care needs.

What SMMC-LTC covers

LTC managed care plans must cover a specified minimum set of services, per AHCA contract requirements. These include both institutional and community-based services:

Nursing facility care (skilled and intermediate)
Personal care assistance at home
Adult day health care
Home health — nursing visits, physical therapy, occupational therapy, speech therapy
Assistive care services and homemaker services
Home-delivered meals
Caregiver training and respite care
Assistive technology and home accessibility modifications
Case management and care coordination
Personal emergency response systems
Transportation to covered services

All services are provided based on medical necessity or the need to delay or prevent nursing facility placement. An LTC plan case manager develops an individualized care plan with each enrollee.

Income and asset rules for Florida nursing facility Medicaid

Florida uses an income cap for nursing facility Medicaid. Applicants whose monthly income exceeds the income cap — approximately $2,829 per month in 2025 — must establish a Qualified Income Trust (QIT), also called a "Miller Trust," to qualify. Income above the cap flows into the trust and is used to pay for cost of care. Without the trust, the applicant does not qualify even if they have low assets.

The asset (resource) limit for an individual is $2,000. Exempt assets include a primary home (if a spouse or dependent relative lives there, or if the applicant intends to return), one vehicle, personal belongings, and prepaid burial funds up to $2,500, per DCF's SSI-Related Programs Financial Eligibility Standards.

For married couples, the Community Spouse Resource Allowance (CSRA) protects a portion of the couple's assets for the at-home spouse. For 2025, the community spouse may keep between $30,828 and $154,140 in countable assets, with the exact amount determined by the total marital assets. The community spouse also retains a Minimum Monthly Maintenance Needs Allowance (MMMNA) from the institutionalized spouse's income.

PACE programs as an alternative to nursing facilities

Programs of All-Inclusive Care for the Elderly (PACE) are available in select Florida counties. PACE is a Medicare-Medicaid integrated program for individuals 55 and older who qualify for nursing home level of care but choose to remain in the community. Participants receive all medical and LTC services through a single PACE organization.

PACE sites operate in several Florida metro areas. Availability is limited. Contact your local ADRC or AHCA for current PACE locations and enrollment information.

Florida files estate recovery claims after a Medicaid recipient's death

AHCA administers Florida's Medicaid Estate Recovery Program (MERP). After a Medicaid beneficiary dies, AHCA may file a claim against the estate to recover costs paid for nursing facility care, home- and community-based waiver services, and related hospital and prescription services provided after age 55. A primary home is generally not seized while a surviving spouse, minor child, or disabled dependent lives in it — but a lien may be placed. Contact an elder law attorney if estate recovery is a concern for your family.

Spousal impoverishment protections at a glance

Federal law (42 U.S.C. § 1396r-5) protects the community spouse when the other spouse enters a nursing facility or SMMC-LTC program. Florida applies these protections under AHCA Medicaid rules.

Protection	2025 amount	Notes
Community Spouse Resource Allowance (CSRA)	$30,828–$154,140	Federal floor/ceiling; Florida uses the minimum floor ($30,828) unless a fair hearing or court order establishes higher amount
Minimum Monthly Maintenance Needs Allowance (MMMNA)	~$2,465/month	2025 federal minimum; allocated from institutionalized spouse's income
Institutionalized spouse asset limit	$2,000	Countable resources only; exempt assets include home (while community spouse occupies it), one vehicle, personal effects

Florida applies the federal minimum CSRA floor by default. A community spouse who believes the minimum is insufficient can request a fair hearing. Consult a Florida elder law attorney for CSRA and MMMNA calculations specific to your situation. Source: AHCA Medicaid LTC rules, 42 CFR 435.726.

Miller Trust (Qualified Income Trust) requirement in Florida

Florida is an income-cap state. When a nursing home or SMMC-LTC applicant's gross monthly income exceeds the income cap (~$2,829/month in 2025), they cannot qualify for LTC Medicaid without a Qualified Income Trust — commonly called a Miller Trust. The applicant's income above the cap is deposited into the trust each month before it is counted for eligibility purposes.

The trust must be established by a Florida attorney before the application is filed. Trust funds are used to pay the patient's share of nursing facility costs, with Medicaid covering the balance. At death, AHCA is the first remainder beneficiary up to the amount Medicaid paid.

Compare: New York does not use Miller Trusts

New York is a "medically needy" (income-spend-down) state, not an income-cap state. Florida and Texas both require Miller Trusts for nursing home applicants whose income exceeds the cap. An elder law attorney licensed in Florida can draft and administer the trust.

What Florida long-term care Medicaid covers

Nursing facility care (unlimited duration once medically necessary and financially eligible)
SMMC-LTC home and community-based services — personal care, homemaker, respite
Adult day health care programs
Assisted living facility services (HCBS waiver)
Medical equipment and supplies for home use
Skilled nursing and therapy services at home
Transportation to medical appointments
PACE (Programs of All-inclusive Care for the Elderly) — in select Florida metro areas
Companion and attendant care through Medicaid waiver programs

Florida operates Medicaid estate recovery (MERP) — AHCA administers

AHCA can seek recovery from the estate of a Medicaid recipient age 55 or older who received nursing facility care, SMMC-LTC services, or related institutional services. Florida's MERP extends to real property interests beyond the probate estate in some cases. A surviving spouse, child under 21, or blind or disabled child prevents recovery during their lifetime. Consult a Florida elder law attorney before making asset transfers. See the national estate recovery guide for context.