Florida Medicaid Guide

Not before you know the spend-down. Many Florida couples have far less to spend than they fear, because the spouse at home may keep up to $162,660. Florida Medicaid generally pays no earlier than the month of application, so each month of waiting is a month paid privately, and money paid to the facility cannot be used for exempt purchases.

The most expensive mistake we see is not a gift or a missed form. It is a frightened family paying the nursing home privately for months before anyone has worked out what the spend-down actually is. "Spend-down" sounds like "pay the nursing home until the money is gone." It does not mean that, and for a married couple in Florida the amount that has to be spent is often much smaller than the family assumes, sometimes nothing.

Reviewed by Carl B. Zacharia, Esq. , Florida Bar No. 50784, author of Florida Long-Term Care and Medicaid · Last reviewed November 9, 2026. Figures shown are the ones Florida applies as of that date.

Why do families pay privately first?

Because the bill arrives before the answers do. A parent moves from the hospital to the nursing home, Medicare's coverage ends (see when Medicare stops paying ), and the business office asks how the family intends to pay. Paying privately feels responsible, and many families believe they have to spend everything before Medicaid will help.

Spend-down means reducing countable assets to the limit in ways the program allows, and paying the facility is only one of them (see the spend-down guide ).

How much does a Florida couple actually have to spend down?

For a married couple, the arithmetic is: the couple's total countable assets, minus up to $162,660 that the spouse at home may keep in 2026, minus the $2,000 the applicant may keep. The home, a car, personal belongings, and other exempt property are not part of the count at all ( DCF Appendix A-9 ; 42 U.S.C. § 1396r-5 ).

Countable assets of $100,000: no spend-down. The whole amount fits within what the couple may keep.
Countable assets of $210,000: a spend-down of about $45,340 .
Countable assets of $400,000: a spend-down of about $235,340 .

These figures assume the assets are countable and properly titled, and that there were no gifts in the look-back period. Ownership, retirement accounts, and timing can all change the result, which is why the number should be worked out before money moves.

What does paying first actually cost?

Consider Clyde and Nancy, adapted from an example in the book. Nancy goes into a nursing home. They have $210,000 in countable assets. Frightened by the bills, Clyde pays the facility privately for four months, about $40,000, before he ever talks to anyone.

He did not need to. Florida would have let him keep up to $162,660, leaving a spend-down of about $45,340. Spent on the right things, such as an irrevocable prepaid funeral for each of them, repairs to the house, a reliable car, and the cost of the application, that money would have stayed with the family as things they needed anyway, and Medicaid could have started paying within a month or two. Paying the facility did count toward the spend-down, but it bought nothing the family kept: $40,000 went to months of care Medicaid could have covered, and the funerals, the repairs, and the car still had to be paid for out of what Clyde had left.

The lesson is not that paying for care is wrong. It is that paying without a plan is how families lose money the law would have let them keep.

Why does every month of waiting cost money?

For most adults, Florida Medicaid coverage starts no earlier than the first day of the month the application is filed; it does not reach back to the months before ( Florida ended retroactive coverage for most adults in 2019 ). DCF puts the average monthly cost of nursing home care in Florida at $10,645. Every month the application waits is, in practice, another month the family pays privately.

The application and the spend-down can move together. The month the countable assets fall under the limit decides the first month Medicaid can pay, so the plan is to know the number early, spend it on the right things, and file in the right month.

What should we spend on instead?

The permitted uses are covered in the spend-down guide . The ones that matter most here are the ones that keep value in the family:

An irrevocable prepaid funeral for each spouse.
Repairs and improvements to the home, which is exempt: a roof, air conditioning, accessibility work.
A reliable vehicle for the spouse at home.
Debts: a mortgage, credit cards, taxes.
The cost of the application, and of any legal work the case needs.

Spending on the applicant or the spouse at fair value is never a transfer. Giving money to children is, and it creates a penalty.

What if the nursing home is asking for payment now?

It is reasonable for a facility to expect to be paid, and once Medicaid is approved the resident pays a monthly patient responsibility from their income. But a nursing home that takes Medicare or Medicaid may not require a family member to personally guarantee payment as a condition of admission or of staying ( 42 C.F.R. § 483.15(a)(3) ). Read the admission agreement before you sign it, and sign as your parent's agent, not as a guarantor. The best answer to the business office is a filed application and a clear plan for the spend-down.

How Senior Care Resources helps

The free assessment works out the spend-down before anything is spent: what counts, what the spouse at home may keep, and which month Medicaid could start. We then prepare and manage the application for a flat fee. When the plan needs legal work, such as a caregiver contract, an annuity, or a Qualified Income Trust, that is done by Zacharia Frey PLLC under a separate engagement, or by any elder law attorney you choose. Start your free Medicaid assessment or call (239) 977-5175.

Adapted from Chapter 18 of Florida Long-Term Care and Medicaid (2026 Edition), by Carl B. Zacharia, with the figures updated to the ones Florida applies today.

Frequently asked questions

Do we have to pay the nursing home until our money runs out before Medicaid will pay?

No. A Florida applicant must reduce countable assets to $2,000, and for a married couple the spouse at home may keep up to $162,660 in 2026, plus the home and a car. Many couples have little or no spend-down. Find out the number before paying the facility privately.

How much can my wife keep if I go into a nursing home in Florida?

Up to $162,660 in countable assets in 2026, plus the home, one car, personal belongings, and other exempt property, and a monthly income of at least $2,705, partly from your income if hers is lower.

Will Florida Medicaid pay for the months before we applied?

For most adults, no. Since 2019, Florida Medicaid coverage generally starts no earlier than the first day of the month of application, so the application should be filed as early as the facts allow.

Can the nursing home make me pay my parent's bill?

A nursing home that takes Medicare or Medicaid may not require a family member to guarantee payment as a condition of admission or of staying. You are generally not personally liable for the bill unless you sign as a guarantor, but an agent who misuses a parent's money, including by giving it away, can be.

Sources

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This page is general information about Florida Medicaid, not legal advice, and nothing here creates an attorney-client relationship. Medicaid rules change and every family’s facts are different.

Senior Care Resources is a separate company from Zacharia Frey PLLC. Its Medicaid application services are not legal services, and no attorney-client protection applies to them. When an attorney becomes involved, that is a separate legal representation with the law firm.