Medicare-Medicaid Pay-Down of Assets
State law and regulations impose income and asset limits on persons applying for Medicaid.
The income limit for the institutional Medicaid program and certain home and community-based waiver programs is determined by the Agency for Health Care Administration and published in the SSI-Related Programs Financial Eligibility Standards. For 2025, the Medicaid income limit for individuals eligible for the Nursing Home (institutional) program is $2,901 per month. The asset limit for an individual is $2,000, or $3,000.
An individual’s income must be within limits established by federal or state law and the Medicaid State Plan. The income limits are as follows:
(a) For MEDS-AD Demonstration Waiver, income cannot exceed 88 percent of the federal poverty level after application of exclusions specified in subsection 65A-1.713(2), F.A.C.
(b) For QMB, income must be less than or equal to the federal poverty level after application of exclusions specified in subsection 65A-1.713(2), F.A.C.
(c) For WD, income must be less than or equal to 200 percent of the federal poverty level after application of exclusions specified in subsection 65A-1.713(2), F.A.C.
(d) For ICP, gross income cannot exceed 300 percent of the SSI federal benefit rate after consideration of allowable deductions set forth in subsection 65A-1.713(2), F.A.C. Individuals with income over this limit may qualify for institutional care services by establishing an income trust which meets criteria set forth in subsection 65A-1.702(15), F.A.C.
(e) For HCBS, gross income cannot exceed 300 percent of the SSI federal benefit rate after consideration of allowable deductions set forth in subsection 65A-1.713(2), F.A.C. Individuals with income over this limit may qualify for HCBS services by establishing a qualified income trust which meets criteria set forth in subsection 65A-1.702(15), F.A.C.
(f) For hospice services, income cannot exceed 300 percent of the SSI federal benefit rate or income must meet Medically Needy eligibility criteria, including the share of cost requirement. Effective October 1, 1998, institutionalized individuals with income over this limit may qualify for institutional hospice services by establishing an income trust which meets criteria set forth in subsection 65A-1.702(15), F.A.C.
(g) For SLMB, income must be greater than 100 percent of the federal poverty level but equal to or less than 120 percent of the federal poverty level.
(h) For Medically Needy, income must be less than or equal to the Medically Needy income standard after deduction of allowable medical expenses.
If an individual’s total resources are equal to or below the prescribed resource limits at any time during the month the individual is eligible on the factor of resources for that month. The total resource limits are as follows:
(a) For Medicaid for the Aged or Disabled Demonstration Waiver (MEDS-AD), an individual whose income is equal to or below 88 percent of the federal poverty level must not have resources exceeding the current Medically Needy resource limit.
(b) For a Qualified Medicare Beneficiary (QMB), an individual cannot have resources exceeding three times the SSI resource limit with increases based on the Consumer Price Index.
(c) For the Working Disabled (WD), an individual cannot have resources exceeding the Medically Needy resource limit.
(d) For a Special Low Income Medicare Beneficiary (SLMB), an individual cannot have resources exceeding three times the SSI resource limit with increases based on the Consumer Price Index.
(e) For the Medically Needy, an individual or couple cannot have resources exceeding the applicable Medically Needy resource limit set forth in subsection 65A-1.716(3), F.A.C.
(f) For the Home and Community Based Services (HCBS) Waiver Program, an individual cannot have countable resources that exceed $2,000. If the individual’s income falls within the MEDS-AD Demonstration Waiver limit, the individual can have resources up to $5,000.
If an individual, the spouse, or their legal representative, disposes of resources or income for less than fair market value on or after the look-back date, the Department must presume that the disposal of resources or income was to become Medicaid eligible and impose a period of ineligibility for ICP, Institutional Hospice or HCBS Waiver Programs. The Department will mail a Notice of Determination of Assets (or Income) Transfer to individuals who report a transfer for less than fair market value, advising of the opportunity to rebut the presumption and of the opportunity to request and support a claim of undue hardship. If the Department determines the individual is eligible for Medicaid on all other factors of eligibility except the transfer, the individual will be approved for general Medicaid (not ICP, Institutional Hospice or HCBS Waiver Programs) and advised of their penalty period using the Medicaid Transfer Disposition Notice. Transfers of resources or income made prior to January 1, 2010, are subject to a 36-month look-back period, except in the case of a trust treated as a transfer, in which case the look-back period is 60 months prior to the application month. Transfers of resources or income made on or after January 1, 2010, are subject to a 60-month look-back period. Assets and income are evaluated for married individuals when one spouse is institutionalized, and one spouse continues to live in the community (referred to as the “community spouse”). The community spouse may be eligible to receive a portion of the institutionalized spouse’s income.