Florida Medicaid operates under the Statewide Medicaid Managed Care (SMMC) framework, which includes three key plan types:
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Managed Medical Assistance (MMA): Covers general medical services like doctor visits, hospital care, prescriptions, mental health, and transportation. Most Medicaid recipients are covered under these plans.
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Long‑Term Care (LTC): For individuals needing nursing facility-level care or home-based support who are 18 +, including seniors and those with certain disabilities.
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Dental Plan: Covers dental services for both kids and adults, and enrollment is mandatory.
Income Limits
To Qualify for Florida’s Long-Term Care (LTCC) Medicaid program you must meet the Income and asset limits, even if you meet the nursing home level of care (and are 18 years or older).
The income limit for an individual applicant is $2,901 in gross monthly income to qualify for the Medicaid Long Term Care benefit. Income includes money from pensions, wages, interest received from any source, IRA distributions, annuity payments, dividends, monthly rental income, and all monies received from social security. If you receive SSI, then you are already eligible. If you are over the Income Limit, then a referral would be made to a trusted Elder Law Attorney who would offer you the legal advice on how you could still qualify for Medicaid by using a Qualified Income Trust.
In general, the Medicaid rule for a nursing home resident is that the applicant must pay all their income to the nursing home except for $160 per month. The resident keeps $160 per month for their own “personal needs allowance” (PNA). Medicaid pays the remainder of the nursing home costs above the resident’s monthly income due to the nursing facility.
For Medicaid applicants who are married, the income of the community spouse is not counted when determining the Medicaid applicant’s eligibility. Only income counted in the applicant’s name is counted towards the Medicaid Income Limit. So even if the community spouse is still working and earning, say, $5,000 a month, this income is NOT counted towards the applicant’s gross income limit per Medicaid. The community spouse’s income will not be included in the amount due to pay the nursing home. However, if the community spouse’s income exceeds a certain level, then he or she would have to make a monetary contribution out of the Medicaid applicant’s income towards the cost of the nursing home care. The maximum amount of monthly income that Medicaid could require to be paid to the nursing facility is the Medicaid applicant’s gross income less $160 for the client’s personal needs. The community spouse’s income is not considered in determining the applicant’s eligibility, but it does affect if the community spouse qualifies to retain some of the applicant’s income with spousal diversion.
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