Medicaid is the national government health insurance program that provides approximately 3,280,000 low-income Florida residents with access to essential health care services, such as physician care, hospital and long-term care. Some additional services, such as community-based supports, may be offered through optional state programs and Medicaid waivers.
To qualify for Medicaid, applicants must meet eligibility requirements that include income and asset limits. Seniors who are eligible to receive Supplemental Security Income benefits automatically qualify for basic Medicaid coverage, and they only need to complete an additional screening if they need long-term residential care services through Medicaid.
In order to qualify for long-term Medicaid funded services, seniors must earn less than $2,313 per month when applying as an individual or under $4,626 per month when applying with a spouse. Income from all sources, such as wages, investment interest and alimony payments, is included in this limit.
Medicaid asset limits are set at $2,000 per individual and $3,000 for a couple. Countable assets include all cash and bank account balances, life insurance policies worth $1,500 or more, stocks and bonds and real estate other than a home in which the applicant and/or their spouse live full-time valued at $585,000.
Spousal Income and Asset Limits and Exemptions
If only one spouse in a married couple needs long-term Medicaid services, the income of the non-applicant spouse (community spouse) isn’t included when determining eligibility.
The applicant spouse may be able to transfer up to $3,161 per month of income to their community spouse as a minimum monthly maintenance needs allowance, and this amount is deducted from the income declared for Medicaid eligibility.
The community spouse may also be able to keep the lesser of 50% of the couple’s jointly held assets or $126,420, excluding the marital home and one vehicle, under the community spouse resource allowance clause.
Statewide Medicaid Managed Care Long-Term Care Program
Seniors aged 65 and older who require the type of care that’s normally provided in a nursing home may qualify for medically necessary care services and support through the Statewide Medicaid Managed Care Long-Term Care program.
The SMMC LTC is a state-specific Medicaid nursing home diversion program that lets frail seniors live in an assisted living setting with help from nurses, care workers, rehabilitation therapists and senior care specialists.
Federal law dictates that all seniors who meet the financial requirements for the SMMC LTC must complete a pre-enrollment screening through the Comprehensive Assessment and Review for Long-Term Care Program. This assessment is performed by a registered nurse or designated assessor to ensure the senior can live safely in the community with the services available through the SMMC LTC.
Seniors accepted into the SMMC LTC are assigned services based on their medical needs in addition to all the mandatory Medicaid benefits. These services may include:
- Personal care to help with activities of daily living
- Intermittent and skilled nursing
- Medication management and administration
- Transportation to medical appointments
- A personal emergency response device
- Adult day health services
- A homemaker
- Medical supplies and durable medical equipment
- Nutritional assessment
- Hospice services
- Physical, occupational and/or speech therapy
To apply for Medicaid or learn more about the SMMC LTC program, contact
ACCESS Florida at (866) 762-2237 or the
Hillsborough County Elder Helpline at (800) 963-5337.
To request a CARES assessment, contact the
Department of Elder Affairs at (727) 376-7152.