How to qualify for Medicaid in Florida in 2026 even if you make too much money
- Ask Medicaid Florida
- 3 hours ago
- 4 min read
For Florida residents, aged 65 and over, who do not meet the financial eligibility requirements above, there are other ways to qualify for Medicaid.
Medicaid Share of Cost
1) Medically Needy Pathway – Florida has a “Share of Cost” Program, also called a “Spend-Down” Program, for persons who apply for Regular Medicaid / Medicaid for Aged and Disabled (MEDS-AD) and have income over the Medicaid limit. This program allows persons to become income-eligible for Medicaid services by spending the majority of their income on medical bills (i.e., health insurance costs, such as Medicare premiums, and medical service bills). In 2026, the medically needy income limit (MNIL) in FL is $180 / month for a single applicant and $241 / month for a married couple. The “spend-down” amount is the difference between one’s monthly income and the MNIL. Once the “spend down” is met, one will be income-eligible for the remainder of the month. The medically needy asset limit is $5,000 for an individual and $6,000 for a couple.
Qualified Income Trusts
2) Qualified Income Trusts (QITs) – Also called Miller Trusts, QITs offer a way for persons over the Medicaid income limit to still qualify for Nursing Home Medicaid or Home and Community Based Services. With this type of irrevocable trust, a sufficient amount of money must be deposited into the account each month to bring the individual’s income down to the Medicaid income limit. “Irrevocable” means the terms of the trust cannot be changed or canceled. A trustee is named and legally controls trust funds, which can only be used for very specific purposes. Examples include paying medical bills, Personal Needs Allowances, and Medicare premiums. The state of Florida must be named to receive any remaining trust funds upon the death of the Medicaid recipient.
Asset Spend Down
3) Asset Spend Down – Persons who have countable assets over FL’s asset limit can “spend down” excess assets on non-countable ones and become asset-eligible. Examples include making home modifications (i.e., addition of wheelchair ramps or stair lifts), prepaying funeral and burial expenses, and paying off debt. Remember, assets cannot be gifted or sold under fair market value. Doing so violates Medicaid’s Look-Back Rule and can result in a Penalty Period of Medicaid ineligibility. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.
People also ask
What is Florida Medicaid share of cost?
The Basics: Your Monthly Share of Cost
Your “share of cost” is essentially a threshold of medical expenses you must incur each month before Medicaid coverage kicks in. This amount is calculated based on: Your household size. Your gross monthly income.
What is cost sharing for Medicaid?
Source: MACPAC analysis of Medicaid state plans and amendments, state regulations and administrative codes, provider manuals and bulletins, Medicaid agency websites, and contact with state officials. Cost sharing is the portion of health care costs that enrollees pay out-of-pocket.
Does Medicaid cover 100% of costs?
States can impose copayments, coinsurance, deductibles, and other similar charges on most Medicaid-covered benefits, both inpatient and outpatient services, and the amounts that can be charged vary with income. All out of pocket charges are based on the individual state's payment for that service.
What is the monthly income limit for Medicaid in FL?
Florida Medicaid income limits vary significantly by eligibility group, but for long-term care (nursing home/waiver), the 2025 gross monthly limit for a single person is around $2,991, while for children and parents, it's based on the Federal Poverty Level (FPL), with different limits for different age groups, and adults under 65 without children or disabilities generally don't qualify unless they meet specific low-income criteria or use trusts. If your income is slightly over the cap, a Qualified Income Trust (Miller Trust) can help you qualify by holding excess income.
For Long-Term Care (Nursing Home & Home/Community-Based Waivers)
Single Person: Approximately $2,991 gross monthly income (as of January 2025).
Married Couple (Both Applying): Around $5,802 total (e.g., $2,901 per spouse).
If Over the Limit: You can use a Qualified Income Trust (Miller Trust) to deposit excess income, making you eligible.
For Children & Families (Based on FPL)
Children < 1 Year Old: Around 211% of FPL (e.g., ~$2,460/month for a family of 1).
Children 6-18: Around 138% of FPL (e.g., ~$1,801/month for a family of 1).
Pregnant Women: Up to 196% of FPL.
For Adults Under 65 (Not Disabled)
Florida has not expanded Medicaid under the ACA, so most adults under 65 who are not disabled or caring for minor children aren't eligible, regardless of income.
Key Things to Remember
Gross Income:
The income limit usually considers your total income before deductions like Medicare Part B premiums are taken out.
Assets Matter Too:
You must also pass an asset test (e.g., typically under $2,000 in countable assets for long-term care).
Official Source:
The Florida Department of Children and Families (DCF) (myflfamilies.com) provides official guidelines.
How do you calculate share of cost?
A beneficiary's share of cost amount is equal to the difference between the individual's net nonexempt income and the applicable state-determined “maintenance need level.”
Related Article
How Florida Medicaid Share of Cost Works
If you're enrolled in the Florida Medicaid Medically Needy "Share of Cost" program, you need to know how to use this complicated health insurance correctly. If you use it incorrectly, you’ll pay more than necessary or miss out on Medicaid coverage you could've received.
This article will explain what Florida Medicaid's "Share of Cost" program is, how it works, and what you need to know in order to maintain your benefits. Read full article.
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