As individuals age or develop chronic medical conditions, they may require long-term care (LTC) services to assist with daily activities such as bathing, dressing, and meal preparation. In Florida, there are various options for long-term care, including home-based care, assisted living, and skilled nursing facilities. However, eligibility for these services depends on multiple factors, including medical necessity, financial status, and program qualification.

If you or a loved one are considering long-term care in Florida, understanding the eligibility requirements and available programs can help you make informed decisions about your future care.

What Types of Long-Term Care Services Are Available in Florida?

Long-term care services are designed to assist individuals who need help with daily living activities due to aging, disability, or chronic illness. These services may be provided in various settings, some of which include:

  • In-Home Care: Assistance with personal hygiene, medication management, and household chores.
  • Assisted Living Facilities (ALFs): Residential care with support services for those who need moderate assistance but do not require nursing home care.
  • Nursing Homes: 24-hour medical care for individuals with serious health conditions.
  • Adult Day Care Centers: Supervised daytime care for seniors who need assistance but live at home.

The type of long-term care service you qualify for will depend on your medical condition, level of independence, and financial resources.

Who is Eligible for Long-Term Care Services in Florida?

Long-term care services are essential for seniors as well as individuals with disabilities who require ongoing assistance with daily activities, medical care, and personal support. In Florida, eligibility for these services is determined by a combination of financial, medical, and functional criteria. Understanding these requirements can help individuals and their families plan for their necessary care while exploring available resources such as Medicaid and private insurance options.

Whether it is you or a loved one who needs in-home assistance, nursing home care, or placement in an assisted living facility, knowing the eligibility requirements is the first step toward securing long-term care services. Below are the three primary criteria for qualifying for long-term care in Florida:

1. Medical Necessity

To qualify for most long-term care programs, individuals must demonstrate that they require assistance with daily activities or ongoing medical care. Common eligibility factors include:

  • Inability to perform Activities of Daily Living (ADLs) such as bathing, dressing, eating, and/or mobility.
  • Cognitive impairments such as Alzheimer’s disease or dementia.
  • Chronic medical conditions requiring nursing care or rehabilitation.

Florida’s Comprehensive Assessment and Review for Long-Term Care Services (CARES) program conducts evaluations to determine an individual’s medical eligibility for Medicaid long-term care services.

2. Financial Eligibility

Many long-term care services in Florida are funded through Medicaid, which has strict financial requirements. To qualify for Medicaid-funded LTC services, an applicant must meet the following:

  • Income Limits: As of January 1, 2025, the income limit for an individual applying for Medicaid long-term care is $2,901 per month.
  • Asset Limits: Individuals must have less than $2,000 in countable assets (excluding primary residence, one vehicle, and personal belongings).
  • Medicaid Planning: Legal strategies, such as Medicaid Asset Protection Trusts or spousal income allowances, may help applicants qualify for benefits while preserving assets for their families.

Those who exceed the income and/or asset limits may still qualify for Medicaid through spend-down programs or qualified income trusts (Miller Trusts).

3. Florida Medicaid Long-Term Care Program Enrollment

Florida provides long-term care services through its Statewide Medicaid Managed Care (SMMC) Long-Term Care Program, which offers:

  • Home and Community-Based Services (HCBS): Care provided in a home or assisted living setting.
  • Institutional Care Program (ICP): Nursing home services for individuals who need full-time care.

Applicants must apply through the Aging and Disability Resource Centers (ADRCs) to enroll in the Medicaid Long-Term Care Program.

What Alternative Long-Term Care Options Are Available in Florida?

For individuals who do not meet the eligibility requirements for Medicaid, there are still several alternative long-term care options available in Florida. Planning for long-term care can be overwhelming, but understanding the different funding sources and programs can help families find the right solution for their loved ones.

From private payment options to specialized programs for veterans and seniors, Florida offers various ways to access quality care without relying solely on Medicaid. Below are some of the most common alternatives:

  • Private Pay Care: Many individuals and families choose to pay out-of-pocket for home care services, assisted living facilities, or nursing home care. While this option provides flexibility and access to high-quality services, it can become financially demanding over time.
  • Long-Term Care Insurance: Private insurance policies are available to cover long-term care expenses, including home health aides, assisted living, and skilled nursing care. These policies vary in coverage and costs, so reviewing policy details early is essential.
  • Veterans’ Benefits: The VA Aid and Attendance Pension provides financial assistance to eligible veterans and their spouses who require long-term care. This benefit can help cover the costs of home care, assisted living, or nursing home services.
  • Florida PACE (Program of All-Inclusive Care for the Elderly): This state program offers a combination of medical and long-term care services to seniors who qualify, allowing them to receive comprehensive care while remaining in their community.

Each of these options comes with different eligibility criteria and financial requirements, so it is important to do your research and seek professional guidance to determine the best path for long-term care needs.

How Can RTRLAW Help with Long-Term Care Planning?

Navigating long-term care eligibility can be overwhelming, especially when dealing with Medicaid applications, financial planning, and legal documents. At RTRLAW, our experienced estate planning and elder law attorneys can assist you with:

  • Medicaid Planning: Legal strategies to protect assets while qualifying for Medicaid.
  • Long-Term Care Applications: Assistance with completing and submitting Medicaid or VA benefit applications.
  • Estate Planning: Creating wills, trusts, and power of attorney documents to safeguard your assets and wishes.
  • Guardianship & Elder Law Services: Legal advocacy for seniors requiring long-term care decisions.

Planning ahead can help secure your financial future and ensure you receive the care you need.

Contact RTRLAW today for a free consultation at (833) HIRE-RTR to learn more about your long-term care options in Florida.