THE INCOME TEST

Florida is one of many states that places an eligibility income “cap” on a Medicaid recipient’s income when receiving Medicaid long-term care benefits.  If the applicant’s income exceeds the cap, even by one dollar, they may not meet this requirement (there is, however, a solution to this problem – see below). 

If there is a spouse not applying for benefits (known as the “Community Spouse”), his or her income is not counted towards the applicant spouse’s income limit. All figures below are as of January 1, 2025.

Income Requirements for the Applicant:  Gross monthly income cannot exceed $2,901.  If income exceeds this level it may still be possible to qualify by establishing and funding an Irrevocable Qualified Income Trust (aka, “QIT” or “Miller” trust) to meet the requirement.

Income Requirements for the Community Spouse:  The Community Spouse may have unlimited income.  The Community Spouse’s own income is not considered in determining the applicant’s eligibility.  See below for spousal income protections where the Community Spouse has low income.

What is Income?

For eligibility purposes Income is defined as gross income not net. For example, most have Medicare Part B premiums subtracted from their Social Security benefit.  This must be added back when determining gross income.  Similarly, many have health insurance premiums, other benefit premiums, or taxes deducted from their pension income.  These, too, must be added back when calculating gross income.

What is considered income?  Virtually every form of income is considered countable. Social Security, pensions, disability benefits, all or a portion of some VA benefits, interest income, non-taxable income, dividends, IRA or other qualified plan distributions, income from annuities, income from ongoing business concerns or income producing property, and any other income the applicant may be receiving is countable income with rare exceptions.  In some cases gifts to the applicant can be considered income.

Patient Responsibility

A Medicaid recipient will almost always has some financial obligation towards their own care while receiving Medicaid benefits. This is called “Patient Responsibility” or “Patient Liability”.

In a nursing home, the Medicaid recipient’s monthly Patient Responsibility will be their gross monthly income minus $160 that they may retain as a “Personal Needs Allowance” to pay for incidentals while residing in the facility.

If in an assisted living facility, the Personal Needs Allowance is the cost of room and board plus 20% of the Federal Poverty Level ($261 for an individual in 2025).

If receiving care at home, the Medicaid recipient keeps all of there income as a Personal Needs Allowance.

Income Protection for the Community Spouse  

The spouse not receiving Medicaid benefits may be concerned about their ability to maintain their own needs if all of their loved one’s income is going to a facility as Patient Responsibility.

The Community Spouse may be able to receive all or portion of the applicant spouse’s income if their own is insufficient to meet a minimum standard.  This standard is called the Minimum Monthly Maintenance Needs Allowance (MMMNA).

The Community Spouse at home may retain a minimum of $2,644 and a maximum of $3,948 of monthly gross joint marital income.  In other words, if the Community Spouse’s income is less than $2,644 per month he/she is entitled to that portion of her/his spouse’s income that will make up the shortfall before any payment to a nursing home or to other Patient Responsibility is made. 

Example:  Shirley has Social Security income of $966 per month.  Her husband, who is in a nursing home and applying for Medicaid, has Social Security income of $1,950.  Virtually all of her husband’s income is required to go to his cost of care.  This is his “Patient Responsibility”; his contribution towards his own cost of care. 

However, because Shirley’s income of $966 is below the $2,644 minimum threshold, she is permitted to receive at the very least $1,678 per month of her husband’s Social Security to make up the difference.

If Shirley has high shelter expenses, and shows evidence of same, she may then be able to receive more of her husband’s income up to the maximum of their combined total monthly income or $3,948, whichever is less.

Once the Income test is met, the applicant must pass the Asset test.

To learn about the Asset Test, click here: