Florida Medicaid eligibility is category-based: you generally must be a child, a pregnant woman, a parent or caretaker relative of a dependent child, or a person who is aged (65+), blind, or disabled. Because Florida has not expanded Medicaid under the Affordable Care Act, most working-age adults without dependent children or a qualifying disability do not have a coverage pathway through the state program, regardless of how low their income is. Income limits vary from about 26% of the Federal Poverty Level (FPL) for parents to 211% for infants, and long-term care applicants face a separate income cap plus asset rules.
Income Limits by Category
Children, pregnant women, and parents are evaluated using Modified Adjusted Gross Income (MAGI), which looks at taxable income and ignores assets entirely. The percentages below already include the built-in 5% FPL disregard, so they can be compared directly to household income.1Medicaid.gov. Medicaid, Childrens Health Insurance Program, and Basic Health Program Eligibility Levels
- Pregnant women: up to 196% of FPL. For a household of two, that is roughly $3,535 per month under 2026 guidelines. Coverage continues for 12 months after the pregnancy ends.
- Infants under age 1: up to 211% of FPL.
- Children ages 1 through 18: up to 138% of FPL. Above that and up to 200% of FPL, kids may qualify for Florida KidCare, the state’s CHIP program, at low monthly premiums.2Florida KidCare. 2025 General Annual Income Guidelines
- Parents and caretaker relatives: the ceiling is far lower. A family of three qualifies at roughly $598 per month, about 26% of FPL.3Florida Department of Children and Families. Determining Your Income Limit
For context, the 2026 FPL in the 48 contiguous states is $1,330 per month for one person, $1,803 for two, and $2,277 for three.4U.S. Department of Health and Human Services, ASPE. 2026 Poverty Guidelines – 48 Contiguous States
Adults Without Dependent Children
There is no coverage category in Florida for non-disabled adults ages 19 to 64 who don’t have dependent children. In expansion states, these adults qualify up to 138% of FPL; in Florida, they do not qualify at all through Medicaid. This is the “coverage gap”: too much income for Medicaid, too little for Marketplace premium subsidies.
Seniors and People With Disabilities Living in the Community
Florida’s MEDS-AD program (Medicaid for Aged and Disabled) provides full Medicaid benefits to people who are 65 or older or have a qualifying disability but don’t need institutional care. The income limits are $1,182 per month for an individual and $1,596 for a couple, with asset limits of $5,000 and $6,000.3Florida Department of Children and Families. Determining Your Income Limit
If your income is at or below the federal SSI benefit rate — $994 per month in 2026 — you likely qualify for SSI-related Medicaid automatically.5Social Security Administration. SSI Federal Payment Amounts for 2026
Long-Term Care: The Income Cap
Nursing home coverage, Home and Community-Based Services (HCBS) waiver programs, and the Program of All-Inclusive Care for the Elderly (PACE) use a different income test. Florida is an “income cap” state: gross monthly income cannot exceed 300% of the SSI federal benefit rate, which is $2,982 per month for a single applicant in 2026.5Social Security Administration. SSI Federal Payment Amounts for 2026
If Your Income Exceeds the Cap
One dollar over $2,982 disqualifies you under normal rules. The workaround is a Qualified Income Trust (QIT), also called a Miller Trust. You or someone with legal authority for you creates the trust, deposits your income into it each month, and the funds are used to pay for care. Any balance in the trust at your death must be repaid to the Agency for Health Care Administration (AHCA).6Florida Department of Children and Families. Qualified Income Trust Fact Sheet
A QIT is not a shelter for your money. It is a legal mechanism to meet the income eligibility test, nothing more.
Asset Limits
MAGI-based programs (children, pregnant women, parents) have no asset test. Non-MAGI programs do.7Florida Department of Children and Families. Chapter 1600 Assets Program MFAM – 1640.0000 SSI-Related
- Long-term care Medicaid (nursing home, HCBS waivers, PACE): $2,000 for an individual, $3,000 for a couple applying together. If your income falls within the MEDS-AD range, the limit rises to $5,000 and $6,000.
- MEDS-AD community Medicaid: $5,000 individual, $6,000 couple.
- Medically Needy: $5,000 individual, $6,000 couple.
What Doesn’t Count
Several important assets are excluded:
- Your primary home, as long as you live there or have stated an intent to return. A signed intent-to-return letter is enough while you’re in a nursing home, and the return does not need to be medically realistic. Home equity above $752,000 (the 2026 Florida figure) is countable, but the equity cap is waived entirely if a spouse, a child under 21, or a blind or disabled child of any age lives in the home.8U.S. Department of Health and Human Services, ASPE. Medicaid Treatment of the Home – Determining Eligibility and Repayment for Long-Term Care
- One vehicle, regardless of value.
- Household goods and personal belongings, regardless of value.
- Up to $2,500 per person in burial funds, if clearly designated and kept separate.9Florida Department of Children and Families. CF-ES-2302, Designation of Resources as Burial Funds
- Irrevocable prepaid funeral contracts and burial trusts, in full.
Retirement accounts like IRAs and 401(k)s are generally counted as available assets in Florida. One common planning move converts a retirement account into an irrevocable annuity that pays out in installments; the annuity has no cash value and is treated as an income stream rather than a countable asset. That conversion has tax consequences, so professional advice is worthwhile before liquidating.
Married Couples: Spousal Protections
When one spouse needs long-term care and the other stays in the community, federal law prevents the state from requiring the community spouse to spend down to nothing.
The Community Spouse Resource Allowance lets the community spouse keep up to $162,660 in countable assets in 2026. Florida applies the federal maximum, so only assets above that figure count toward the institutionalized spouse’s eligibility.10Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
The Minimum Monthly Maintenance Needs Allowance sets an income floor of $2,643.75 per month for the community spouse in 2026. If the community spouse’s own income falls below that floor, a portion of the institutionalized spouse’s income can be redirected to make up the shortfall before the rest goes toward the cost of care.
The Five-Year Look-Back
Long-term care applicants have every asset transfer from the previous 60 months reviewed. Gifts, sales below market value, and transfers to family members without fair compensation are treated as attempts to qualify artificially.11Centers for Medicare and Medicaid Services. Transfer of Assets in the Medicaid Program
The penalty is a period of ineligibility, calculated by dividing the total value of improper transfers by the average monthly cost of private nursing home care in Florida. Critically, the penalty clock does not start on the transfer date. It starts when you apply and would otherwise qualify. Giving away $100,000 four years before applying does not run out the clock the way many families assume.
Some transfers are exempt: transfers to a spouse, to a blind or disabled child, or to a trust for the sole benefit of a disabled person under 65. The “caretaker child exemption” may also apply when a home is transferred to a child who lived there and provided care that delayed the parent’s need for institutional care.
Medically Needy: Spending Down to Qualify
If your income is too high for standard Medicaid but you have heavy medical expenses, the Medically Needy program can help. Instead of a fixed income limit, you meet a monthly “share of cost.”
Florida sets the Medically Needy Income Level at $180 per month for an individual and $241 for a couple.12Florida Department of Children and Families. Appendix A-7 – Family-Related Medicaid Income Limit Chart Your share of cost is the difference between your countable income and that level. If you earn $900 and are single, your share of cost is $720. Once you’ve incurred $720 in qualifying medical bills in a given month, Medicaid covers the rest of that month. The counter resets on the first of every month.13Florida Senate. Medicaid Medically Needy Program Review – Interim Project Report 2001-024
Qualifying expenses include health insurance premiums (Medicare included), deductibles, copayments, and bills for medical services recognized under state law. Amounts paid by third parties don’t count.14Medicaid.gov. Implementation Guide – Medicaid State Plan Eligibility Handling of Excess Income Spenddown Asset limits of $5,000 for an individual and $6,000 for a couple still apply.
Estate Recovery After a Recipient’s Death
Florida law requires AHCA to recover the cost of Medicaid benefits paid on behalf of anyone who received assistance after age 55. Benefits paid before 55 create no debt.15The Florida Legislature. Florida Statutes 409 – 0409.9101
Recovery cannot be enforced when the recipient is survived by a spouse, a child under 21, or a child who is blind or permanently disabled. It also cannot reach property that is exempt from creditor claims under state law, and Florida’s homestead protection is among the strongest in the country. Heirs may request a hardship waiver, though losing an expected inheritance does not itself qualify as hardship.
How to Apply
Applications go through the Florida Department of Children and Families (DCF), not AHCA. Online applications are handled at MyACCESS. You can also call DCF’s customer call center at 850-300-4323 or visit a local service center. Expect to provide proof of income, residency, and citizenship or lawful immigration status. Non-MAGI programs also require asset documentation.
If a Qualified Income Trust is part of your plan, have the trust document prepared before you file. Long-term care applications take longer than MAGI-based ones because of the asset verification and the five-year look-back review. Applying as soon as institutional care becomes likely reduces the risk of a coverage gap during which the family pays the full private-pay rate.