Medicaid long-term care

Florida Medicaid long-term care: nursing homes, assisted living and care at home

Medicare doesn't pay for long-term custodial care. In Florida, Medicaid does, through the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program for people 65 and older, or 18 and older with a disability, who need a nursing-home level of care. Nursing home care is covered when you qualify; care at home or in assisted living has a priority-based wait list.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 14, 2026

What the SMMC Long-Term Care program is

Florida Medicaid delivers long-term care through managed care plans in the Statewide Medicaid Managed Care Long-Term Care (LTC) program. Three agencies share the work: AHCA runs the program and enrolls people in an LTC plan, the Department of Children and Families (DCF) decides financial eligibility, and the Department of Elder Affairs' CARES program decides medical eligibility and level of care.

You're eligible if you have Medicaid and are 65 or older, or 18 or older with a disability, and CARES finds you need nursing facility care (or hospital-level care for cystic fibrosis). Medicaid recipients who meet these rules receive long-term care through an LTC plan, whether or not they have Medicare (s. 409.979(1)). The LTC plan covers long-term care only; your medical care comes from Medicare and, with full Medicaid, your Medicaid medical plan.

What LTC plans cover

By law every LTC plan must cover at least (s. 409.98):

Nursing facility care and hospice
Services in assisted living facilities
Adult day care, personal care, home-delivered meals, and respite care for caregivers
Intermittent and skilled nursing, medication administration and management, and therapies
Medical equipment and supplies, home accessibility changes, personal emergency response systems, and caregiver training
Case management and transportation to LTC services

Medicare, by contrast, covers only short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. See Does Medicare cover nursing home care in Florida?

How the wait list works for care at home or in assisted living

Space for home and community-based LTC services is limited, so Florida keeps a statewide pre-enrollment list (s. 409.979(3)):

Screening. A phone screening about your health and daily needs gives you a priority score. People with a low score aren't placed on the list but can ask to be screened again if their situation changes.
Waiting by priority. People are released by priority score, and by the oldest list date when scores tie, when AHCA reports open capacity and funds exist.
Assessment. After release, a doctor, nurse practitioner or physician assistant completes a medical form, and CARES staff visit you in person to decide your level of care.
Financial eligibility. DCF decides whether you qualify for Medicaid and mails you the result.
Enrollment. AHCA sends a welcome packet. Choice counselors (1-877-711-3662) help you pick an LTC plan; you can change plans in the first 120 days.

Some people are enrolled without waiting, including a nursing home resident of at least 60 consecutive days who wants to move back to the community and certain Adult Protective Services referrals (s. 409.979(3)(f)). AHCA's Long-Term Care program page explains how to start. Nursing home residents who qualify for Medicaid don't go through this list.

Nursing home Medicaid: income, assets and the Miller trust

Nursing home Medicaid in Florida is the Institutional Care Program (ICP). Home and community-based LTC uses the same income rule.

Rule	What Florida requires
Income cap	Gross income no higher than 300% of the SSI federal benefit rate (65A-1.713). DCF lists the dollar amount in Appendix A-9.
Over the cap	A Qualified Income Trust (Miller trust): irrevocable, holding only your income, set up for your benefit, and paying the state what's left at your death up to what Medicaid paid. You deposit enough each month to bring countable income under the cap (ESS 1840.0110).
Assets	An individual asset limit equal to SSI's, with higher amounts for a couple (A-9). Your home can be excluded while you, your spouse or a dependent relative lives there, or while you state that you intend to return home (ESS 1640.0543.01), subject to a home equity limit.
Spouse at home	Spousal impoverishment rules let a spouse living at home keep part of the couple's assets and income (A-9 lists the current amounts).
Your income after approval	Most of it goes toward the cost of your care; you keep a personal needs allowance set by DCF (ESS 2640.0118).

60-month look-back. When you apply for nursing home care, home and community-based LTC or PACE, DCF reviews gifts and other transfers for less than fair value in the 60 months before you apply (ESS 1640.0608). An improper transfer can lead to a period when Medicaid won't pay for long-term care.

PACE in Florida

PACE (Program of All-Inclusive Care for the Elderly) provides Medicare and Medicaid care through one team, often based at a PACE center. You must be 55 or older, live in a PACE service area, meet a nursing-home level of care, and choose PACE as your only source of Medicare and Medicaid services; PACE uses the same financial rules as nursing home Medicaid (ESS 2040.0823). AHCA's September 2026 report lists 12 PACE organizations. PACE is available in about two dozen counties, mostly in South Florida, the Tampa Bay and Orlando areas, Jacksonville and the western Panhandle, with more applications pending; not every county has it.

Estate recovery

Under Florida's Medicaid Estate Recovery Act (s. 409.9101), Medicaid paid for you after age 55 becomes a claim against your estate. Payments before 55 don't count. The state doesn't recover while you're survived by a spouse, a child under 21, or a child who is blind or permanently and totally disabled, and it doesn't take property that Florida law protects from creditors, such as protected homestead. Heirs can ask for a hardship waiver. Help from a Medicare Savings Program alone isn't recovered under federal law (42 U.S.C. 1396p(b)(1)(B)(ii)).

How it fits with Medicare

Medicare stays your main coverage for doctors, hospitals and drugs, and you get Extra Help automatically with Medicaid.
A FIDE SNP, a Medicare Advantage plan that also holds Florida's Medicaid LTC contract, can cover your Medicare and Medicaid long-term care together. CMS lists 3 FIDE SNPs in 42 Florida counties for 2027. See D-SNPs in Florida.
Problems with an LTC plan's services go to the AHCA Medicaid Helpline, 1-877-254-1055. For nursing home or assisted living complaints, the Long-Term Care Ombudsman Program is at 1-888-831-0404; suspected abuse goes to the Florida Abuse Hotline, 1-800-962-2873.

See also Florida Medicaid and Medicare and What is the SMMC Long-Term Care program? To review Medicare plan options from the companies they work with, you can request a call from a licensed insurance agent.

Sources

Frequently asked questions

Does Florida Medicaid pay for assisted living?

Yes, through the SMMC Long-Term Care program, which must cover services provided in assisted living facilities (s. 409.98). You need a nursing-home level of care. Home and community-based LTC, including assisted living, has a wait list.

What are the Florida Medicaid income limits for nursing home care?

For the Institutional Care Program, gross income can't exceed 300% of the SSI federal benefit rate (Fla. Admin. Code 65A-1.713). People with income above that can still qualify by setting up a Qualified Income Trust. DCF publishes the current dollar limits in its Appendix A-9.

What is a Qualified Income Trust (Miller trust) in Florida?

An irrevocable trust that holds only your income. You deposit enough each month to bring your countable income under the limit, the trust pays toward your care, and the state receives what's left at your death, up to what Medicaid paid (ESS 1840.0110).

Is there a waitlist for Florida Medicaid long-term care at home?

Yes. Home and community-based LTC services have a statewide pre-enrollment list. A phone screening gives you a priority score, and people are released from the list by score as funding allows (s. 409.979(3)). Nursing home residents aren't on this list.

Does Medicare pay for a nursing home in Florida?

Only for short skilled nursing facility stays after a qualifying hospital stay, up to 100 days per benefit period. Medicare doesn't pay for long-term custodial care; that's where Florida Medicaid's LTC program comes in.

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