The American long-term-care system is largely paid for by Medicaid — not Medicare. Medicare covers short rehab stays after a hospital admission, then stops. The bill for ongoing nursing-home care, memory care, or in-home support past that window has to be paid by someone, and for the majority of US seniors, that someone is the state Medicaid program.1

Florida runs its Medicaid long-term-care benefit through two programs: the Institutional Care Program (ICP) for nursing-home care, and the Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) waiver for home and community-based services. Both have the same financial eligibility rules. The differences are in what they pay for and where.

Three eligibility tests, in order

1. Medical eligibility

Before the financial math starts, your parent has to be medically eligible. In Florida this means a CARES (Comprehensive Assessment and Review for Long-Term Care Services) evaluation. A nurse and social worker visit, score the parent on activities of daily living, and determine whether they meet the nursing-home level of care.2

CARES is required regardless of whether you want institutional or community-based care. Schedule it early. Wait times can run two to eight weeks depending on the county.

2. Income

Florida’s income cap for Medicaid long-term care is $2,829/month(300% of the federal benefit rate for 2026; this number changes annually). If your parent’s gross monthly income from all sources — Social Security, pension, IRA distributions, annuity payments — exceeds that, they’re notautomatically disqualified. They’ll need a Qualified Income Trust (QIT), sometimes called a Miller Trust.

3. Assets

This is where families lose months and tens of thousands of dollars to bad advice. The applicant’s countable assetsmust be at or below $2,000 at the moment of application. “Countable” is doing a lot of work in that sentence.

Not counted (in most cases):

Counted:

The five-year look-back, in plain English

Florida (like every state) reviews any transfer of assets for less than fair market value made in the 60 months prior to the application. If you find one, Medicaid assesses a penalty period— a window during which the parent is otherwise eligible but Medicaid won’t pay.

The penalty math is straightforward: the value of the transfer divided by Florida’s penalty divisor (currently ~$10,809/month in 2026). A $100,000 gift becomes roughly a nine-month penalty. The clock on that penalty does not start until your parent is otherwise eligible— meaning they’ve spent down to $2,000 and are in care. So the penalty hits exactly when the family needs Medicaid most.

When to start planning

The honest answer: yesterday, if you can. The realistic answer: as soon as you see meaningful decline. The reasoning is the look-backmath — legitimate planning tools (spend-down on exempt assets, certain trust structures, spousal transfers) work well at the five-year mark and progressively worse the closer you get to the application date.

That doesn’t mean it’s ever too late. Plenty of families plan in the final 6–18 months and still meaningfully improve the outcome. It just means the toolkit narrows.

The community-spouse situation

If one spouse needs care and the other doesn’t, the rules get more favorable. The well spouse (the “community spouse”) keeps:

Most one-spouse-needs-care situations can be planned to a non-catastrophic outcome with 12–24 months of lead time. Talk to a Florida elder-law attorney before doing anything — DIY in this scenario is where we’ve seen the most expensive mistakes.

What to do this month

For the broader context on Medicaid eligibility nationally, see our Medicaid pillar overview. For the Florida-specific legal and estate-planning side, see Legal & Financial in Florida.