Your dad moved into a nursing home in Tampa after a fall, and Medicare's rehab days are almost up. The business office says he should apply for Medicaid. You've heard about income trusts, the homestead and a five-year look-back, and you want to understand the rules before anyone signs anything.
This guide follows Florida's own rules: the DCF Economic Self-Sufficiency (ESS) Program Policy Manual and Chapter 65A-1 of the Florida Administrative Code56. We don't list dollar figures, because they change, usually each January. Instead, we explain how each limit works and point to the official tables in the ESS manual. For decisions about property, trusts or gifts, talk with DCF or a Florida elder law attorney.
Who can qualify for ICP
To get ICP benefits, Florida's rule says a person must meet the general Medicaid requirements and must be6:
- Living in a licensed nursing facility that is a Medicaid provider, or in certain hospital swing beds or hospital-based skilled nursing beds.
- Determined to need institutional care under Florida's medical criteria.
- Aged 65 or older, or blind or disabled under SSI rules.
- A Florida resident and a U.S. citizen or qualifying noncitizen.
- Within the income and asset limits, or using a qualified income trust for income.
Someone in a nursing home can also apply for a home and community-based waiver, but can't have waiver and ICP coverage at the same time6. See Medicaid waivers for home care.
Medical eligibility: the CARES assessment
Florida's Comprehensive Assessment and Review for Long-Term Care Services (CARES) program, run by the Department of Elder Affairs with the Agency for Health Care Administration, decides medical eligibility, or level of care, for Medicaid nursing home services2. A CARES nurse or assessor completes an assessment at no cost to the applicant, and a CARES physician or nurse reviews it2. The assessment also recommends the least restrictive, most appropriate setting2.
Ask the nursing home social worker whether the CARES assessment has been requested and completed. A financial approval can't take effect without the medical side.
Medicare first, then Medicaid
Many Florida families start this process after a hospital stay. Medicare may cover a limited stay in a skilled nursing facility for rehab after a qualifying inpatient hospital stay7. Medicare doesn't pay for long-term custodial care, which is why families turn to Medicaid once rehab ends or progress stalls. See when Medicare stops paying for a nursing home.
It's wise to start gathering documents and talking with the business office while Medicare is still paying. Florida Medicaid can take time to approve, and the qualified income trust, the CARES assessment and the asset review all need to line up. Starting early reduces the chance of a gap in which your parent owes the nursing home directly.
A simple planning timeline
- At admission. Ask whether the facility accepts Medicaid and who in the business office handles applications.
- First two weeks. Collect income and asset records, and list any gifts or property transfers in the past five years1.
- If income is over the cap. Have the qualified income trust drafted and the account opened, and start monthly deposits3.
- Before Medicare days run out. Submit the application through MyACCESS and confirm the CARES assessment has been requested82.
- After approval. Read the notice showing the patient responsibility amount, pay it to the nursing home each month, and calendar the renewal date.
Keep copies of everything you send, with dates, and note the name of each person you speak with.
The income limit
For ICP, an individual's gross income can't exceed 300 percent of the SSI federal benefit rate3. Because the SSI rate changes each year, the dollar amount usually changes in January. The ESS manual's Appendix A-9 lists the current standard3. Gross income means income before deductions such as Medicare premiums or tax withholding. It includes Social Security, pensions, annuities, interest and other regular payments.
Over the income limit: qualified income trusts
Many Floridians have income above the cap but not enough to pay privately for a nursing home. Florida allows a qualified income trust, sometimes called a Miller trust. Under the ESS manual, a trust qualifies if it is irrevocable, contains only the person's income, such as Social Security or a pension, and says the state receives what remains at death, up to the amount Medicaid paid3.
The person or their representative must deposit enough income into the trust account in the month it's received to bring the income outside the trust under the limit, and must do so each month eligibility is wanted3. DCF sends each trust to legal counsel to confirm it qualifies34. Income placed in the trust isn't counted for the income test, but all income still counts when figuring how much your parent pays toward care3. The trustee must provide quarterly statements of deposits3.
The asset limit
For ICP, Florida uses the SSI asset limit for an individual or an eligible couple, with a somewhat higher limit if the person's income is within the MEDS-AD program limit1910. These limits are small. The current amounts are in Section 1640.0205 of the ESS manual and in Rule 65A-1.716110. A person is eligible on assets for a month if total assets are at or under the limit at any time during that month9.
Florida follows SSI rules for most exclusions, with some state-specific ones9:
- One automobile, regardless of value.
- Life insurance cash value when total face value is under a small set amount.
- A set amount for burial funds for the person and spouse.
- A life estate interest in real property.
- Property essential to self-support in certain cases.
To learn how families lawfully reduce countable assets, see Medicaid spend-down.
The home
A home that is the person's principal residence is excluded from assets regardless of the type of ownership1. A homestead can stay excluded under an intent to return when your parent is away from the home, such as in a nursing home1. Florida also applies a federal home equity limit: someone whose equity interest is above the standard in Appendix A-9 isn't eligible for nursing home services unless a spouse, a child under 21, or a blind or disabled child lives in the home111. Undue hardship exceptions exist1.
For what happens to the house over time, see can a nursing home take your house and Medicaid estate recovery.
When one spouse stays at home
Florida applies federal spousal impoverishment rules to ICP. The community spouse, the one who stays at home, keeps a Community Spouse Resource Allowance, which is subtracted from the couple's combined countable assets before the nursing home spouse's eligibility is decided112. Income owned only by the community spouse isn't counted in deciding whether the nursing home spouse is eligible3. Part of the nursing home spouse's income may also be set aside for the spouse at home if their own income is low12.
Transfers by the community spouse to other people can still trigger penalties1. Talk with DCF or an attorney before moving money.
The 60-month look-back
DCF reviews any transfer of assets made in the look-back period before the application, or any time after applying. For transfers not involving trusts, the look-back is 60 months, counting back from the month of application1. Each transfer is checked to see whether your parent received fair compensation. If not, a period of ineligibility for nursing home services may apply111.
Gifts to family, selling property to a relative below its value, and some deed changes can all raise questions. See the Medicaid look-back period and caregiver agreements with family.
Patient responsibility
Once your parent is approved, most of their monthly income goes toward the cost of care. Florida calls this patient responsibility. It is figured from all of your parent's income, including income placed in a qualified income trust3, minus a personal needs allowance and any amount set aside for a spouse at home12. Medicaid pays the rest of the nursing home's Medicaid rate. Ask DCF for the current personal needs allowance, which is listed in the ESS manual's appendix.
How to apply in Florida
- Check the facility. Confirm the nursing home is a Medicaid provider6. See how to choose a nursing home.
- Gather documents. ID, Social Security and pension statements, five years of bank and investment statements if transfers may be reviewed, life insurance and burial policies, deeds and vehicle titles.
- Apply through MyACCESS. Submit the application online through DCF's MyACCESS Florida8, or with help from the nursing home's business office.
- Request the CARES assessment. Medical eligibility is decided separately by CARES2.
- Fund the trust if needed. Make the qualified income trust deposits every month that coverage is needed3.
- Answer requests quickly. Missing a DCF deadline can delay or deny the application.
For general steps, see how to apply for Medicaid for an elderly parent.
Common mistakes Florida families make
- Signing a trust no one funds. An executed income trust only helps in months when enough income is deposited3.
- Gifting before applying. Transfers inside the 60-month window can lead to a penalty period1.
- Waiting on the medical side. Without the CARES level-of-care decision, approval stalls2.
- Assuming the spouse must spend everything. The community spouse keeps a protected allowance1.
- Missing renewal notices. Coverage must be renewed. Watch the mail and the MyACCESS account.
If DCF denies the application or applies a penalty, the notice explains how to request a fair hearing and the deadline.
Getting help
Florida's Aging and Disability Resource Centers and the nursing home's business office can help with forms. The long-term care ombudsman can help if a nursing home pressures your parent to leave while an application is pending. See nursing home eviction. For a wider look at Florida care costs, see how to pay for assisted living in Florida, and for other big states, see Texas Medicaid nursing home eligibility and Medi-Cal nursing home eligibility in California.
