Florida Medicaid: Income Limits, Applying, and Estate Recovery

Florida Medicaid eligibility depends entirely on which group you fall into. The program covers low-income children, pregnant women, parents and caretaker relatives, seniors, and people with disabilities, and each group has its own income rules. Some also face an asset test. Because Florida has not expanded Medicaid under the Affordable Care Act, most non-disabled adults without dependent children cannot qualify no matter how little they earn. The Agency for Health Care Administration runs the program, but applications go through the Department of Children and Families.

Income Limits for Children, Pregnant Women, and Parents

Florida uses Modified Adjusted Gross Income (MAGI) for these groups. There is no limit on savings or other assets; only income counts. The thresholds are expressed as a percentage of the Federal Poverty Level:1Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels

  • Infants under age 1: household income up to 206% FPL.
  • Children ages 1 through 5: up to 140% FPL.
  • Children ages 6 through 18: up to 133% FPL.
  • Pregnant women: up to 191% FPL.
  • Parents and caretaker relatives: roughly 24% FPL, a fixed dollar figure that works out to only a few hundred dollars a month for a family.

That parent threshold catches people off guard. A single parent earning even modest wages will usually be over it. If your children are ineligible for Medicaid because your income is too high but falls below 210% FPL, they may still qualify for Florida KidCare, the state’s separate CHIP program.1Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels

Rules for Seniors and People With Disabilities

The Aged, Blind, and Disabled (ABD) and Long-Term Care (LTC) categories use different math. Applicants here must pass both an income test and an asset test.

For 2026, the gross monthly income cap for an individual applying for institutional or long-term care Medicaid is $2,982, which is 300% of the federal SSI benefit. If your income exceeds this cap, you can still qualify by setting up a Qualified Income Trust (sometimes called a Miller Trust), which holds the excess income and distributes it under Medicaid rules.

The countable asset limit for a single applicant is $2,000. Not everything counts, though. Exempt resources include:

  • Your primary home, as long as the equity is below the state’s home equity limit, which CMS adjusts annually.
  • One vehicle, typically exempt regardless of value.
  • Irrevocable burial contracts and a small burial fund.
  • Household goods, clothing, and other personal belongings.

When one spouse enters a nursing facility and the other stays in the community, Florida lets the community spouse keep a portion of the couple’s combined assets under the Community Spouse Resource Allowance (CSRA). The amount is adjusted each year and is designed to keep the healthy spouse from becoming impoverished. The community spouse can also retain a minimum monthly income allowance from the institutionalized spouse’s income if their own income falls below a set floor.

If Your Income Is Too High: The Medically Needy Program

If your income exceeds the standard limits but you have significant medical expenses, Florida’s Medically Needy program can bridge the gap. It works like a monthly deductible. The state calculates your “share of cost” based on household size and income, and once your medical bills for that month reach that amount, Medicaid covers the rest of the month.2Department of Children and Families (Florida). Medically Needy Program: An Explanation of Share of Cost

You meet the share of cost by submitting documentation of qualifying expenses to DCF. Unpaid medical bills not previously used, bills paid within the last three months, health insurance premiums, copays, prescriptions, and ambulance or transit costs to reach care all count. Over-the-counter supplies like bandages and cold remedies do not.2Department of Children and Families (Florida). Medically Needy Program: An Explanation of Share of Cost

The share of cost resets every month, so you have to meet it again each time. Submit proof through the MyACCESS online portal, by fax, by mail, or in person. Expenses from any household member whose income was counted in the eligibility determination can be used, even if that person is not personally Medicaid-eligible.2Department of Children and Families (Florida). Medically Needy Program: An Explanation of Share of Cost

How to Apply

Applications go through the Department of Children and Families, not AHCA. The easiest route is the online ACCESS Florida portal at myaccess.myflfamilies.com. You can also mail or fax a paper application, or apply in person at a local DCF office or community partner.

Have these documents ready:

  • Proof of identity, such as a birth certificate or driver’s license.
  • Social Security numbers for everyone in the household.
  • Proof of Florida residency, like a utility bill or lease.
  • Current income verification, such as pay stubs or a letter from your employer.
  • For ABD and LTC applicants, asset documentation: bank statements and property records.

Federal regulations give the state up to 45 days to process a standard application, or up to 90 days if a disability determination is required. During that time, DCF may ask for more information. Respond quickly. Slow responses to document requests are one of the most common reasons applications stall or get denied.

When Coverage Starts

For most adult applicants age 21 and older who are not pregnant, coverage begins on the first day of the month you file your application. Florida ended three-month retroactive coverage for this group in February 2019, so medical bills from before your application month generally will not be covered.

Retroactive coverage of up to three months before the application date is still available for children under 21 and for pregnant women. If you fall into one of those groups and had qualifying medical expenses in the three months before applying, those may be covered as long as you were otherwise eligible during that period. If you have outstanding hospital bills, the timing of your application can directly affect how much you owe.

The Five-Year Look-Back for Long-Term Care

Long-term care Medicaid comes with an extra layer of scrutiny. When you apply, the state reviews every asset transfer you made during the five years before your application. This look-back is meant to stop people from giving away money or property to meet the $2,000 asset limit and then qualifying for Medicaid the next day.

If the state finds transfers for less than fair market value in that window, it imposes a penalty period during which you are ineligible for LTC benefits. The length of the penalty is the value of what was transferred divided by the average monthly cost of nursing home care in Florida. A $100,000 gift to a family member can translate into many months of ineligibility.

Some transfers are exempt. Transferring your home to a spouse, a disabled child, or a child under 21 does not trigger a penalty. Neither does a transfer to a sibling who already has an equity interest in the home and lived there for at least a year before you entered a facility, or to a caretaker child who lived with you for at least two years before your institutionalization and provided care that delayed the need for facility placement. Anyone thinking about LTC Medicaid should sort out asset transfer questions well before applying. Undoing a penalty after the fact is extremely difficult.

Estate Recovery After Death

After a Medicaid recipient who got long-term care benefits dies, Florida can seek reimbursement from the estate for what the program paid. This is estate recovery, and it most often reaches the family home when the recipient owned it at death.

Several situations protect the home:

  • A surviving spouse is alive. The state cannot pursue the home regardless of whether the spouse lives there.
  • The deceased had a child under 21, or a child of any age who is permanently disabled or blind.
  • An adult child lived with the recipient for at least two years before institutional placement and provided care that delayed the need for nursing facility services.
  • The home passes directly to heirs outside of probate and the will does not direct that the home be sold.

Estate recovery is one of the most consequential parts of Medicaid for families with real property, and planning around it before a crisis makes a significant difference in what a family ultimately keeps.

Keeping Your Coverage

Medicaid eligibility is not permanent. The state reviews your case periodically, and you have to complete a renewal (also called redetermination) to keep coverage. DCF mails a renewal notice to the address on file. Missing the deadline terminates your benefits automatically.

The most common reason people lose coverage they still qualify for is a missed renewal, usually because the notice went to an old address. Log into MyACCESS regularly and keep your mailing address, phone number, and email current. If your renewal packet comes back undeliverable, DCF will close your case without further contact.

If you believe your coverage was ended incorrectly, you have the right to request a fair hearing. Timing matters. Requesting a hearing before the termination takes effect can keep your benefits active while the appeal is pending. If you missed the deadline, you may still be able to reapply and, depending on the circumstances, get retroactive reinstatement.