Long-Term Care Medicaid in Florida: How Married Couples Can Protect Assets

How Florida Couples Use Long-Term Care Medicaid & the Spousal Refusal Strategy

By: Mark Shalloway, Certified Elder Attorney

When a spouse needs home health care, assisted living, or nursing home placement, many Florida families believe they must spend down their life savings before qualifying for Florida Long-Term Care Medicaid. That belief is widespread, but it is often incomplete, and in some cases, flat-out wrong.

Florida’s Long-Term Care Medicaid program, administered through the Florida Department of Children and Families (DCF) under its Integrated Policy Manual, contains important protections for married couples. One of the most misunderstood, and most strategic, tools available is the Spousal Refusal strategy.

When used properly, it can allow a married couple to preserve substantial assets while still securing Medicaid coverage for long-term care.

What Florida Long-Term Care Medicaid Actually Pays For

Many people assume Medicaid only pays for nursing homes. In Florida, that is not the case.

Florida’s Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program can provide:

• 5–8 hours per day of home health aide services
• Incontinence supplies (diapers)
• Transportation to doctors and adult day centers
• Adult day care and memory disorder programs
• Meals
• Assistive technology (Life Alert devices)
• Light home modifications (grab bars, ramps)
• Most prescription medications

In assisted living facilities (ALFs):

• Medicaid can pay the care portion of the monthly cost.
• The resident pays room and board (rent and meals).
• Personal income (such as Social Security) is generally applied toward the room and board amount.

Approximately 95% of Florida nursing homes accept Long-Term Care Medicaid.

Once approved:

• The Medicaid recipient contributes his or her monthly income (Social Security, pension).
• Certain deductions are allowed.
• Medicaid pays the balance of the approved rate.

How Florida Long-Term Care Medicaid Protects Married Couples

Florida Medicaid is a needs-based program, but the rules provide specific protections for married couples when only one spouse requires long-term care.

For a Single Applicant:

• Home (if exempt)
• One vehicle
• $2,000 in countable assets

For a Married Couple (One Spouse Applying):

• Applicant spouse: $2,000
• Well spouse (Community Spouse): up to approximately $150,000 (adjusted annually)
• Exempt assets: primary residence and one vehicle

Countable assets include:

• Checking and savings accounts
• CDs
• Stocks and bonds
• Mutual funds
• Annuities
• IRAs
• Other real estate

The Five-Year Look-Back Rule

Florida enforces a 60-month (five-year) look-back period.

If assets were gifted, transferred for less than fair market value, or removed from ownership within five years before applying for Medicaid, they must be disclosed.

A penalty period is calculated based on the value transferred. The penalty delays Medicaid eligibility roughly equal to the time the gifted funds would have paid for care.

Transfers between spouses are not penalized.

The Spousal Refusal Strategy in Florida

Florida formally recognized the Spousal Refusal strategy around 2000.

Conceptually, the strategy works as follows:

1. The married couple transfers countable assets to the well spouse.
2. The well spouse may hold assets in excess of the typical $150,000 allowance.
3. The well spouse signs a Spousal Refusal form, stating he or she refuses to make assets available for the institutionalized spouse’s care.
4. The Medicaid applicant signs an Assignment of Rights, allowing the State to step into his or her shoes to seek contribution from the refusing spouse.

Because transfers between spouses are permitted under federal and Florida Medicaid policy, the five-year look-back rule is not triggered.

To date, there are no reported Florida cases in which the State has aggressively pursued a refusing spouse for contribution under this structure.

Why This Matters for Florida Families

Without proper planning, a married couple may be forced to spend down life savings, liquidate investments, and deplete retirement accounts before one spouse receives help paying for care.

With careful planning under Florida Long-Term Care Medicaid, the well spouse may retain financial independence, the sick spouse receives needed care, and the family can avoid catastrophic financial hardship.

Planning Zones

Green Zone – Pre-crisis planning while healthy.

Yellow Zone – Functional decline and early care discussions.

Red Zone – Immediate need for home health care, assisted living, or nursing home placement.

Planning options may exist in all three zones, but earlier planning typically allows for more flexibility.

A Certified Elder Law Attorney Can Help

If you or a loved one are planning ahead while healthy, facing diagnosis or decline, or dealing with immediate long-term care needs, there may be options.

Every case is different.

Every balance sheet is different.

Every family dynamic is different.

Do not assume you must go broke before qualifying for care.

Consult with an experienced Florida Elder Law attorney who understands Long-Term Care Medicaid planning and spousal refusal strategies.

Frequently Asked Questions About Florida Long-Term Care Medicaid

Can a spouse refuse to pay for nursing home care in Florida?

Under certain circumstances, Florida law allows a strategy known as spousal refusal, where the healthy spouse declines to make assets available for the institutionalized spouse’s care. This strategy must be carefully structured and should be evaluated with an experienced elder law attorney.

How much money can a spouse keep if the other spouse goes on Medicaid?

When one spouse applies for Florida Long-Term Care Medicaid, the community spouse may retain a portion of the couple’s assets. The exact allowance is adjusted annually and is designed to prevent the well spouse from becoming impoverished.

Does Medicaid take your house in Florida?

In many cases, a primary residence may be considered an exempt asset for Medicaid eligibility purposes. However, Medicaid estate recovery rules and long-term planning considerations can affect how the home is treated.

Can Medicaid pay for assisted living in Florida?

Yes. Florida’s Statewide Medicaid Managed Care Long-Term Care program may cover the care portion of assisted living services, while the resident typically pays for room and board.

Written by Mark Shalloway, Certified Elder Law Attorney and founder of Shalloway & Shalloway, P.A.

This article is for educational purposes only and does not constitute legal advice. Medicaid rules change and eligibility depends on individual circumstances.