Requirements For Medicaid in Florida      


Medicaid and Assisted Living Facilities

Many states offer Medicaid waivers to their residents as a way to help them pay for                                                               community-based long-term care, however Florida ended all of their Home and Community                                                   Based Services (HCBS) Waivers on March 1, 2014. The primary HCBS Waiver for seniors in                                                     Florida was the Assisted Living for the Elderly Medicaid Waiver, which covered assisted living                                                   costs for roughly 5,000 Florida residents each year before the program was shut down.                                                         Now, all long-term care is provided through Florida’s HMMC programs, including assisted                                                       living.

Upon request, We Are Family can assist potential residents who wish to apply for the Medicaid Waiver program. Understanding how to qualify for Medicaid in Florida is the first step to completing a successful application. Before applying, it is important to ask, “What are the requirements for Medicaid in Florida?” and more specifically, “What are the income requirements for Medicaid in Florida?” since Medicaid has many stringent eligibility requirements in order to guarantee only qualified applicants truly in need of medical assistance are accepted into the program. Understanding who is eligible for Medicaid and what the Florida Medicaid eligibility requirements are, enable  applicants to maximize preparation for their application, thus increasing their possibility of receiving medical assistance. Click here to submit your request for assistance.

To qualify, every applicant, regardless of his or her situation, must meet the following requirements:

  • Applicants must be United States citizens.

  • Applicants must be residents of Florida.

  • Applicants must meet the annual salary limits

  • Applicants must meet the assets ownership limits


What are the income requirements for Medicaid in Florida?

The income requirements for Medicaid in Florida were established to prevent individuals who are not in financial need of medical assistance from applying. This eligibility requirement for Medicaid is because the program is designed to provide low-income families and individuals in need of health care services with affordable coverage. To be eligible for Medicaid benefits and categorized as low-income, individuals and families seeking health care assistance must generally fall below 133 percent of the federal poverty level. However, this percentage increases for pregnant women and infants. Additionally, household salary requirements for Medicaid in FL fluctuate depending on the size of the household. If there are more household members, the salary needed to qualify for Medicaid increases, and if there are fewer household members, the salary limit decreases. To learn more about specific income level requirements, Click here to submit your request for assistance.


Income Trusts

Income trusts are a legal way to qualify for Medicaid nursing home coverage when you have too much income.

In these states, when a Medicaid applicant receives income that exceeds the monthly amount allowed by Medicaid, the applicant can become eligible by redirecting some or all of that income to an income trust. Income trusts are a type of special purpose trust that can be helpful to Medicaid applicants in states like Florida that have a set income limit for qualifying for Medicaid, such. Referred to as Qualifying Income Trusts in Florida, they are used when a Medicaid applicant has too much income to qualify for Medicaid but not enough to pay for nursing home care or other long-term care costs. In Florida, when a Medicaid applicant receives income that exceeds the monthly amount allowed by Medicaid, the applicant can become eligible by redirecting some or all of that income to an income trust.

What is a Qualified Income Trust? 

If your income is over the limit to qualify for Medicaid long-term care services (including nursing home care), a Qualified Income Trust (QIT) allows you to become eligible by placing income into an account each month that you need Medicaid. The QIT involves a written agreement, setting up a special account and making deposits into the account. 

Who needs a Qualified Income Trust? 

You need a QIT if your income before any deductions (such as taxes, Medicare or health insurance premiums) is over the limit to qualify for the Institutional Care Program (ICP), Institutional Hospice, Program of All-Inclusive Care for the Elderly (PACE) or the Home and Community Based Services (HCBS) waivers. 

What are the Medicaid application guidelines in Florida?

Applicants must be able to prove they satisfy the basic Florida Medicaid requirements in order to meet Medicaid application guidelines in Florida. Proof of Medicaid eligibility typically consists of supplemental documentation that verifies an applicant’s identity, citizenship status and gross household income. Additionally, any applicant who does not meet Medicaid eligibility requirements and may be eligible for another assistance program need only submit one application to Florida’s Department of Children and Families. While an FL Medicaid application partially consists of verifying an applicant’s eligibility, there is much more information an applicant should be prepared with before submission. Click here to submit your request for assistance. 


What Long-Term Care Services Does Medicaid Cover in Florida?

Florida Medicaid is among the most comprehensive medical assistance programs in the United States. Their SMMC programs are required by law to cover the following long-term care services:

  • Adult companions

  • Adult Day Care

  • Assistive Care Services

  • Assisted Living Facility Services

  • Attendant Care

  • Behavior Management

  • Caregiver Training

  • Case Management

  • Home Accessibility Adaptation

  • Home Delivered Meals

  • Homemakers

  • Hospice

  • Intermittent and Skilled Nursing

  • Durable Medical Equipment & Supplies

  • Medication Administration

  • Medication Management

  • Nursing Homes

  • Nutritional services

  • Occupational Therapy

  • Personal Care

  • Personal Emergency Response Systems (PERS)

  • Physical Therapy

  • Respiratory Therapy

  • Respite Care

  • Speech Therapy

  • Transportation

However, certain services have additional criteria for what Medicaid will cover, including assisted living.

What are disqualifications for Medicaid in Florida?

Although an applicant can always appeal their Medicaid eligibility determination, it is important to prevent disqualification from the program by reviewing Medicaid eligibility requirements before completing an application. A common reason applicants fail to meet FL Medicaid benefits eligibility is because they do not meet income requirements. Additionally, in Florida, many applicants do not meet the special circumstances the Florida Medicaid program requires to be eligible to receive benefits. For example, an applicant may be 133 percent below the federal poverty line, but he or she may be 25 years of age with no kids. This applicant will not qualify for Medicaid under Florida statue because Florida requires applicants be children, pregnant, disabled or elderly. Click here to submit your request for assistance.

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