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Florida Medicaid planning: 2026 limits, the 60-month look-back and estate recovery
Florida long-term care Medicaid in 2026: the $2,000 asset limit, the $2,982 income cap, spousal protections, the 60-month transfer look-back and penalty, exempt transfers, and the estate recovery claim under § 409.9101.
Updated October 2026
Long-term care Medicaid pays for nursing facility care and for home and community-based services. Two tests decide eligibility: a level-of-care finding and a financial test. A Medicaid recipient who was 55 or older when the assistance was paid creates a debt that the State can claim against the recipient's estate after death.
- Who is eligible: a person age 65 or older, or age 18 or older and eligible by reason of a disability, whom the Comprehensive Assessment and Review for Long-Term Care Services (CARES) screening finds to require nursing facility care (§ 409.979(1), Fla. Stat. (2026)).
- Assets: $2,000 for a single applicant. Florida applies the SSI resource limit, and for home and community-based waiver programs states $2,000 (Fla. Admin. Code R. 65A-1.712(1); CMS, April 27, 2026).
- Income: gross income may not exceed 300 percent of the SSI federal benefit rate, which is $2,982 a month in 2026. A person over the cap may qualify by establishing an income trust (Fla. Admin. Code R. 65A-1.713(1)(d), (e); CMS).
- Look-back: transfers for less than fair market value within 60 months before the first date the person is both institutionalized and has applied can cause a period of ineligibility (Fla. Admin. Code R. 65A-1.712(3); 42 U.S.C. § 1396p(c)(1)(B)).
- Spouse: a community spouse may keep resources up to $162,660 in 2026 (Fla. Admin. Code R. 65A-1.712(4)(c); CMS).
- Recovery: the claim is filed in the probate proceeding and is not enforced while a spouse, a child under 21, or a blind or permanently and totally disabled child survives (§ 409.9101(3), (6)).
2026 figures
The Centers for Medicare & Medicaid Services published the 2026 SSI and spousal impoverishment standards in an updated bulletin dated April 27, 2026. Table 1 lists each figure with its source.
| Item | 2026 figure | Source |
|---|---|---|
| SSI federal benefit rate (individual) | $994 a month | CMS bulletin |
| Resource limit, individual / couple | $2,000 / $3,000 | CMS bulletin; R. 65A-1.716(5)(a); R. 65A-1.712(1) |
| Income cap, institutional care and waiver programs (300 percent of the federal benefit rate) | $2,982 a month gross | CMS bulletin; R. 65A-1.713(1)(d), (e) |
| Community spouse resource allowance | Florida allows the federal maximum, $162,660 (federal minimum $32,532) | R. 65A-1.712(4)(c); CMS bulletin |
| Maximum monthly maintenance needs allowance | $4,066.50 | CMS bulletin |
| Minimum monthly maintenance needs allowance (effective July 1, 2026) | $2,705 | CMS bulletin |
| Home equity limit | Federal range $752,000 (minimum) to $1,130,000 (maximum) | CMS bulletin; R. 65A-1.712(5)(a) |
| Look-back period | 60 months | R. 65A-1.712(3); 42 U.S.C. § 1396p(c)(1)(B)(i) |
| Average monthly private-pay nursing facility rate used to compute the penalty | $9,703 | R. 65A-1.716(5)(d) |
| Burial funds a person and a spouse may each designate | $2,500 | R. 65A-1.712(2)(d) |
Rule 65A-1.716(5)(d) states "The average monthly private pay nursing facility rate is $9,703." The rule text was last amended effective September 22, 2021 (history line of the rule). The Department of Children and Families published a notice of rule development for rule 65A-1.716 on July 31, 2026. The CMS home equity range is federal; the figure Florida applies within that range is set in Department policy, which is not quoted here. Resource and income figures change each January.
How to qualify, in order
- 1. Level of care. CARES screens for the need for nursing facility care (§ 409.979(1)(b)).
- 2. Choose the setting. Enrollment in home and community-based services through the long-term care managed care program is subject to the availability of funds. The Department of Elder Affairs keeps a statewide pre-enrollment list and releases people by a frailty-based priority score (§ 409.979(2), (3)).
- 3. Resources. Total countable resources at or below the limit in any day of the month meet the test for that month (R. 65A-1.712(1)).
- 4. Income. Gross income at or below $2,982, or an income trust for the excess (R. 65A-1.713(1)(d), (e); trustee quarterly statements in R. 65A-1.702(13)(d)).
- 5. Transfers. The Department reviews transfers within the 60-month look-back (Table 3).
- 6. Residence. For a person 21 or older not in an institution, the State of residence is the State where the person is living and intends to reside, including without a fixed address (42 C.F.R. § 435.403(h)(1)).
What counts and what is excluded
| Resource | Treatment | Source |
|---|---|---|
| Home | Subject to the home equity limit. The limit does not apply when the applicant's spouse, child under 21, or blind or disabled child of any age lives in the home. The limit can be waived for demonstrated hardship. | R. 65A-1.712(5)(a) |
| One automobile | Excluded regardless of value | R. 65A-1.712(2)(e) |
| Burial funds | Up to $2,500 each for the individual and spouse may be designated | R. 65A-1.712(2)(d) |
| Life insurance | Cash surrender value excluded if the combined face value is $2,500 or less | R. 65A-1.712(2)(c) |
| Life estate interest in real property | Value excluded | R. 65A-1.712(2)(b) |
| Property essential to self-support | Excluded if producing income consistent with its fair market value | R. 65A-1.712(2)(f) |
| Long-term care partnership policy | Resource disregard equal to the insurance benefit payments made | R. 65A-1.712(2)(g); 42 U.S.C. § 1396p(b)(1)(C) |
| Continuing care retirement community entrance fee | Counted as a resource | R. 65A-1.712(5)(b) |
| Blocked account | Counted as a resource even if a court petition is required to withdraw | R. 65A-1.712(5)(c) |
Transfers, the penalty and exempt gifts
If an applicant, the spouse or a representative disposes of resources or income for less than fair market value on or after the look-back date, the Department presumes the disposal was made to become eligible and imposes a period of ineligibility for the institutional care program, institutional hospice and waiver programs (R. 65A-1.712(3)).
- A home transferred to the applicant's spouse, to a child under 21 or a blind or disabled child, to a sibling with an equity interest who lived in the home for at least one year before institutionalization, or to a son or daughter who lived in the home for at least two years before and provided care that let the applicant stay at home.
- Assets transferred to the applicant's spouse, or to another person for the sole benefit of the spouse.
- Assets transferred to a trust solely for the benefit of a blind or disabled child, or of a disabled individual under age 65. See the special needs trust guide.
- A transfer shown to be for a purpose other than qualifying for Medicaid, or fully returned.
| Point | Rule | Source |
|---|---|---|
| Look-back | 60 months, counted back from the first date the person is both institutionalized and has applied. Federal law applies the 60 months to transfers made on or after February 8, 2006 (42 U.S.C. § 1396p(c)(1)(B)(i)). Rule 65A-1.712(3) states a 60-month look-back for transfers made on or after January 1, 2010, and 36 months for earlier transfers except trusts, which are 60 months. | 42 U.S.C. § 1396p(c)(1)(B); R. 65A-1.712(3) |
| Length of penalty | Total uncompensated value divided by the average monthly private-pay nursing facility rate ($9,703). The Department calculates down to the day and does not round. | R. 65A-1.712(3); R. 65A-1.716(5)(d) |
| When it starts | The latest of: the day the person is eligible and would be receiving institutional care but for the penalty; the first day of the month of the transfer; the first day after an existing penalty ends. There is no limit on its length. | R. 65A-1.712(3)(g); 42 U.S.C. § 1396p(c)(1)(D) |
| Return of assets | If all transferred assets are returned, the penalty is eliminated | R. 65A-1.712(3)(g) |
| Irrevocable trust | The portion from which no payment could ever be made to the individual is treated as an asset disposed of when the trust was established; the portion that could be paid to the individual is a resource | 42 U.S.C. § 1396p(d)(3)(B) |
| Annuity | Treated as a transfer unless the State is named beneficiary, the annuity is irrevocable and non-assignable, pays equal amounts with no balloon or deferral, and is actuarially sound | R. 65A-1.712(3)(b) |
| Undue hardship | No penalty if the penalty would endanger life or health or deprive the person of food, clothing, shelter or other necessities, and all efforts to access the assets are exhausted | R. 65A-1.712(3)(c)5. |
Worked example computed from these rules: a $100,000 gift divided by $9,703 is a penalty of 10.3 months. The months run only after the applicant is otherwise eligible and in care. A gift made more than 60 months before that date is outside the look-back.
The statute exempts these transfers from the penalty (42 U.S.C. § 1396p(c)(2); R. 65A-1.712(3)(c)):
Married applicants
| Rule | Detail | Source |
|---|---|---|
| Countable resources | All countable resources of both spouses, owned jointly or separately, are considered | R. 65A-1.712(4)(a) |
| At application | Only countable resources above the community spouse resource allowance are considered available to the institutionalized spouse | R. 65A-1.712(4)(b) |
| Allowance | Equal to the federal maximum ($162,660 in 2026) or any court-ordered support, whichever is larger | R. 65A-1.712(4)(c) |
| Higher allowance | At a fair hearing, the allowance may be increased to the amount needed to produce a single-premium lifetime annuity income that brings the community spouse's income up to the minimum monthly maintenance needs allowance | R. 65A-1.712(4)(e) |
| Waiver programs | The spousal impoverishment policies are not applied to home and community-based waiver programs, except the Familial Dysautonomia and Model (Katie Beckett) waivers | R. 65A-1.712(4) |
| Transfers between spouses | Exempt from the transfer penalty | 42 U.S.C. § 1396p(c)(2)(B) |
Worked example computed from rule 65A-1.712(4): a couple with $300,000 in countable resources, minus a $162,660 allowance, leaves $137,340 counted toward the institutionalized spouse's $2,000 limit.
Estate recovery after death
The Medicaid Estate Recovery Act, § 409.9101, Fla. Stat. (2026), creates a debt for medical assistance paid after the recipient reached 55. Payment of benefits to a person under 55 creates no debt (§ 409.9101(3)). Federal law requires recovery for nursing facility services, home and community-based services, and related hospital and prescription drug services (42 U.S.C. § 1396p(b)(1)(B)).
| Point | Rule | Source |
|---|---|---|
| How the claim is made | The agency files a statement of claim against the estate in the probate proceeding and becomes an interested person | § 409.9101(2), (3) |
| Notice to the agency | If the decedent was 55 or older, the personal representative serves the notice to creditors and a death certificate on the Agency for Health Care Administration within 3 months after the first publication of the notice to creditors, unless the agency already filed a claim | § 733.2121(3)(d) |
| Priority | Class 3, after costs and expenses of administration (class 1) and funeral expenses up to $6,000 (class 2) | § 733.707(1) |
| Survivors who block enforcement | A spouse; a child under 21; a blind or permanently and totally disabled child | § 409.9101(6) |
| Exempt property | No debt is enforced against property exempt from creditors' claims under the Florida Constitution or laws | § 409.9101(7) |
| Hardship waiver | The personal representative or an heir may request a waiver. Criteria include the heir living in the decedent's home for the 12 months before death and owning no other residence; deprivation of necessities; full-time care that delayed nursing home entry by a sibling or child who lived with the recipient at least a year; or sale costs equal to or above the property's value. Losing an anticipated inheritance alone is not hardship. | § 409.9101(8) |
| Sale to satisfy the claim | Nonexempt personal property or real property that is not protected homestead may be sold if the costs of sale will not exceed the proceeds. Real property is not transferred to the agency. | § 409.9101(10) |
| Settlements | The agency's claim for third-party liability is satisfied first, then the estate-recovery share is one-half of the remaining settlement proceeds in the estate | § 409.9101(9) |
| Cap | The agency's recovery cannot exceed the total Medicaid assistance provided | § 409.9101(9) |
| Revocable trust | A trust the decedent could revoke at death is liable for the expenses of administration and the estate's obligations to the extent the estate is insufficient, except retirement trusts described in § 733.707(3)(a) | § 733.707(3) |
| Time to amend | The agency may amend its claim as of right up to 1 year after the last date medical services were rendered | § 409.9101(4) |
Property that passes by a Lady Bird deed or by beneficiary designation is addressed in the Lady Bird deed guide and the homestead guide. The statute provides the claim is filed in the probate proceeding; § 409.9101 does not state that non-probate assets are outside the claim.
Working People with Disabilities program
Ch. 2026-88, Laws of Fla., created § 409.9041 and took effect on May 21, 2026, when approved by the Governor (act). The program lets a working adult with a developmental disability keep Medicaid waiver eligibility. The enrollee must be 18 or older, employed with earned income, and enrolled in a listed home and community-based waiver, including the long-term care managed care program. Monthly income may not exceed 550 percent of the SSI federal benefit rate, which is $5,467 at $994 (computed). The agency and the Department of Children and Families disregard assets up to $13,000 for an individual and $24,000 for a couple and exclude IRS-recognized retirement accounts from asset limits.
Sources
Last checked: October 17, 2026. Statutes are cited to the 2026 Florida Statutes on the Florida Senate site.
- CMCS Informational Bulletin, Updated 2026 SSI and Spousal Impoverishment Standards, April 27, 2026. Centers for Medicare & Medicaid Services.
- Fla. Admin. Code R. 65A-1.712, R. 65A-1.713, R. 65A-1.716 and R. 65A-1.702. SSI-related Medicaid resource, income and trust criteria. Department of Children and Families. Rule text read on the Cornell LII copy of the Florida Administrative Code; the effective dates match flrules.org (65A-1.712 and 65A-1.713: January 12, 2020; 65A-1.702: March 25, 2020; 65A-1.716: September 22, 2021).
- 42 U.S.C. § 1396p. Liens, adjustments and recoveries; transfers of assets; trusts.
- 42 C.F.R. § 435.403. State residence.
- § 409.9101, Fla. Stat. (2026). Recovery for payments made on behalf of Medicaid-eligible persons.
- § 409.979 and § 409.9041, Fla. Stat. (2026). Long-term care managed care eligibility; Working People with Disabilities program.
- § 733.2121 and § 733.707, Fla. Stat. (2026). Notice to creditors; order of payment of expenses and obligations.
- Ch. 2026-88, Laws of Fla. (CS/HB 915), approved May 21, 2026.
— Common questions
What people ask us about this.
How much can I have and still qualify for nursing home Medicaid in Florida?
$2,000 in countable resources for a single applicant, and gross income of no more than $2,982 a month in 2026, or an income trust for the excess. The home, one automobile of any value, burial funds up to $2,500 each, and life insurance with a combined face value of $2,500 or less are among the excluded resources (Fla. Admin. Code R. 65A-1.712 and 65A-1.713).
What is the Medicaid look-back period in Florida?
60 months for transfers made on or after February 8, 2006 under federal law (42 U.S.C. § 1396p(c)(1)(B)(i)); rule 65A-1.712(3) states 60 months for transfers on or after January 1, 2010. A transfer for less than fair market value on or after the look-back date draws a period of ineligibility equal to the uncompensated value divided by the average monthly private-pay nursing facility rate, $9,703 in rule 65A-1.716(5)(d). The penalty starts when the person is otherwise eligible and in care.
Will Medicaid take my house?
The home is excluded as a resource up to the home equity limit, which is a federal range of $752,000 to $1,130,000 in 2026. After death, § 409.9101 lets the State claim against the estate in probate, but the debt is not enforced while a spouse, a child under 21, or a blind or disabled child survives, and not against property exempt from creditors under the Florida Constitution or laws.
Can I give my house to my child without a penalty?
Federal law exempts a home transferred to a child under 21, a blind or disabled child, or a son or daughter who lived in the home for at least two years before the applicant entered an institution and provided care that let the applicant stay home (42 U.S.C. § 1396p(c)(2)(A)). Other gifts within 60 months draw a penalty.
How much can the spouse of a nursing home applicant keep?
In Florida the community spouse resource allowance is the federal maximum, $162,660 in 2026, or court-ordered support if larger (rule 65A-1.712(4)(c)). A fair hearing can increase it if the allowance does not bring the community spouse's income up to the minimum monthly maintenance needs allowance (rule 65A-1.712(4)(e)).
What if my income is above $2,982 a month?
Rule 65A-1.713(1)(d) and (e) say an individual with income over the limit may qualify for institutional care or home and community-based services by establishing an income trust. The trustee of a qualified income trust provides quarterly statements to the Department identifying all deposits and disbursements for each month (rule 65A-1.702(13)(d)).
Is a living trust protected from Medicaid estate recovery?
Section 733.707(3) makes a trust the decedent could revoke at death liable for the expenses of administration and the estate's obligations to the extent the probate estate is insufficient. Section 409.9101 provides that the State files its claim in the probate proceeding. Whether a particular asset is reachable depends on those two sections and the exempt-property rule in § 409.9101(7).
Does long-term care insurance affect Medicaid eligibility?
A qualified long-term care partnership policy gives a resource disregard equal to the insurance benefits paid (rule 65A-1.712(2)(g); 42 U.S.C. § 1396p(b)(1)(C)). The rule gives the disregard to a beneficiary of a qualified State Long-Term Care Insurance Partnership Policy.
Can a snowbird qualify for Florida Medicaid?
For a person 21 or older not residing in an institution, the State of residence is the State where the individual is living and intends to reside, including without a fixed address (42 C.F.R. § 435.403(h)(1)).
How do I get home care instead of a nursing home?
Home and community-based services through the long-term care managed care program require a CARES finding of need for nursing facility care, and enrollment depends on available funds. The Department of Elder Affairs keeps a pre-enrollment list and releases people by frailty-based priority score (§ 409.979).
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