How to Get Florida Medicaid to Pay for Nursing Home: A Complete Guide
Facing the prospect of nursing home care for a loved one is tough. Figuring out how to get Florida Medicaid to pay for it can feel overwhelming. It’s tough to deal with all the forms, eligibility requirements, and confusing language, but remember, you’re not in this by yourself. Want to understand Medicaid? This guide covers eligibility, the application, and the benefits you can receive.
Nursing home care is expensive. The average monthly cost for a semi-private room in a Florida nursing facility exceeds $13,000. This can quickly deplete savings. Many families turn to Medicaid. People with low incomes and few assets can get help affording healthcare—even long-term care—thanks to this joint federal and state program.
Are you caring for someone who lives in Northeast Florida? Tell us about your situation by clicking here and visiting our Contact page and our experienced elder law attorney will guide you through the process.
How to Get Florida Medicaid to Pay for Nursing Home Care
Medicaid can be a lifeline, but qualifying isn’t always easy. Let’s walk through how to get Florida Medicaid to cover nursing home costs.
The nursing home benefit is that the Florida Agency for Health Care administration will pay the nursing home a reimbursement rate, and you will pay your income. Your payment of income is called, “patient responsibility” or “patient liability”.
You need to understand the differences between a nursing home and an assisted living facility. Care services in nursing homes provide full custodial care in a hospital-like setting where there are nurses stations and hospital beds. Assisted living facilities is more like college dorms and the resident has a higher capability than a nursing home.
The term “long-term care” is too broad. Long-term nursing care is a more accurate description. Long-term care Medicaid is broken out between ICP and HCBS benefits.
The Medicaid program that pays nursing homes is called the Institutionalized Care Program or ICP. Most facilities accept Medicaid, and many facilities do not require Medicaid approval as a condition for admission. Medicaid nursing homes are not necessarily “scary” or “dirty”.
ICP benefits do not pay for assisted living facility care. A different Medicaid program pays for assisted living facility care.
If you cannot afford the private pay monthly nursing home payment, you need to seek Medicaid benefits to cover the high costs of 24/7 care.
1. Understand Nursing Home Medicaid Eligibility
Medicaid has strict financial eligibility requirements. Florida Department of Children and Families determines nursing home Medicaid eligibility for benefits.
In Florida, your countable assets must be below $2,000 for a single person. Certain items are exempt, like your home and car. These assets do not count toward the asset limit.
The asset limit for married couples changes every year. in 2025 it is $157,920. The asset limit for married couples can be unlimited using the spousal refusal planning option, but you need to understand the consequences.
A good elder law attorney may offer helpful legal advice. This is especially helpful if your family’s income or assets are too high to meet Medicaid’s limits. Florida income limits misconceptions wrongly deter families from getting the care support they need.
The Florida nursing home Medicaid (ICP) income limit in 2025 is $2,901. The Florida DCF casework looks at your gross income, not your net deposits in the bank account.
If your gross income exceeds this income limit, then a qualified income trust or pooled trust is required to lower your income below this threshold. Coutntable Medicaid income affects what you pay each month to the nursing home.
2. The Application Process
The next step is the Florida Medicaid application process. Begin by requesting an AHCA Form 3008 and the nursing home will process the level of care with Florida Department of Elder Affair’s CARES division.
You then share your income, assets, and health information with DCF.
DCF caseworkers will check your financial requirements by requesting additional information or “verification” from you. You’ll need to produce financial records or face denial.
Medicaid rules differ in every state, so denials are possible. Patience and attention to detail during the application process matter. A lawyer may be helpful.
3. Level of Care
Medicaid covers nursing home care when medically necessary. Most Florida nursing homes accept Medicaid as a form of payment.
Your loved one’s doctor is examining them. This uses the AHCA Form 3008 to see if skilled nursing care is needed around the clock.
The evaluation process takes into account your overall health—that includes your body, mind, and any medical conditions. This is part of how to get Florida Medicaid to pay for nursing home.
4. Five-Year Look-Back Period
Florida Medicaid has a five-year look-back period. DCF checks financial records from up to five years ago. Applicants who’ve shifted large sums of money lately may face penalties.
When you have money moving between accounts, you’ll have to explain it or face disqualification. Assets transferred to family “to hold” can still be problematic.
Things like investments and property bring in money. Other income-producing assets are also included. Transferring these to avoid medical expense liability can incur a Medicaid penalty. The penalty delays Medicaid coverage of nursing home expenses if transfers occur within five years of the Medicaid application.
In-home care and government-sponsored assisted living fall under this, too. Financial planning includes considering how Medicaid will affect you. This is a crucial step many people overlook. Careful planning now can save you significant stress later.
5. Notice of Case Action Approving Florida Nursing Home Medicaid Coverage
Florida nursing homes consider ICP Medicaid approved when the State of Florida issues a Notice of Case Action or NOCA. The NOCA should give an accurate amount the nursing home resident must pay each month.
Next, the nursing home resident selected a managed care company to administer the Medicaid benefits that Florida pays to it. Then, the managed care company pays the nursing home. Unlike many states, Medicaid payments are not a deal breaker for many nursing homes in Florida.
FAQs about how to get Florida Medicaid to pay for nursing home
Does Medicaid pay for home health care in Florida?
Yes, Florida Medicaid may cover some home health care costs. This allows some people to stay home instead of needing a nursing facility. Covered services might include skilled nursing, physical therapy, and personal care. Medicaid eligibility for this is similar to nursing home Medicaid.
Who pays for most nursing home care?
Medicaid is the single largest payer for nursing home care in the US. Most people exhaust personal funds before qualifying. Many people end up with minimal assets by the time they apply.
What is the 5-year rule for Medicaid in Florida?
Florida Medicaid’s five-year look-back period reviews asset transfers. This is to avoid someone transferring assets and qualifying with a lower amount than they have. Medicaid may delay coverage of nursing home medical expenses for recent large gifts. Home healthcare and elder care are included too.
Does Florida Medicaid pay for assisted living care?
Yes, the Florida Medicaid plan provides payment assistance for assisted living facilities. This is provided via a Home and Community-Based Services (HCBS) waiver. Assisted living through the HCBS Waiver program may help with housing costs. Some assisted living facilities accept Medicaid in Florida, you have to ask the particular living facility.
We’ve reached the end.
Getting Medicaid to pay for nursing home care takes planning, preparation, and persistence. It can seem tricky, but the right information and support can make this manageable. Learning all you can about how Medicaid can help with paying nursing home expenses can bring peace of mind during a tough transition.
From personal experience, this process adds an emotional burden when an aging family member declines. It is easier handled earlier. Consult an elder law attorney for legal and financial strategies. Getting the right Medicaid coverage for senior nursing care can be tricky. Let them help you qualify. Need help with Medicaid planning or applying for a Medicaid Waiver? They can answer your questions. Eligibility standards and waivers vary by facility, agency, and state. The amount of Medicaid assistance depends on income and need, regardless of the specific facility or assisted living program.
Government benefits from the Affordable Care Act (ACA) lower monthly premiums for Medicaid recipients. Consider private care when planning for health and eldercare. Federal programs have details you need? A Social Security attorney or a case manager near you can help. Explore your choices when medical bills for your family get too high. Many resources are available, so you should ask frequently asked questions and ask a Medicaid planning professional how to best handle paying medical costs. Less stress and more time? Yes, please! This is a huge time saver and a real worry-reducer.
Medicaid provides medical expense relief. Financial worries? This helps lessen the load and safeguards family assets. Better healthcare and insurance can be yours, along with lower housing costs—all thanks to understanding HCBS Waivers.
We help caregivers looking after aging or disabled adults who live in Northeast Florida. Describe your current circumstances. Just click here. Stop by and see our Contact page.
