What are the Income Limits for Medicaid?

The income limits for Medicaid can depend on your age, family size, and the program from which you are requesting benefits. Learn about these limits before you apply for Medicaid. That way, you can determine your eligibility for various Medicaid benefits and submit your application materials accordingly. 

Speak with a Medicaid planning lawyer in Boca Raton as you prepare your benefits request. Your lawyer can teach you about your Medicaid income limits. From here, they can provide you with legal guidance and support as you plan for your long-term care. 

What are the Income Limits for Medicaid in Florida? 

In Florida, your age, family size, and the program that you are applying for can dictate your Medicaid income limits. Along with this, Florida uses income limits based on the Federal Poverty Level (FPL) to determine Medicaid eligibility. It sets income limits for different groups (children, pregnant women, parents) as percentages of the FPL. 

Some states have expanded Medicaid under the Affordable Care Act (ACA). These states typically use a 138% FPL income threshold for adults to qualify for free or low-cost health coverage. Florida has not expanded Medicaid. As such, Florida has low income thresholds that can make it difficult for the state’s low-income residents to get Medicaid. 

Florida’s Medicaid income limits for different groups represent percentages of the FPL, but these percentages tend to be much lower than those in expansion states. Because of this, if you’re an adult in Florida with an income above 100% FPL but below 138% FPL, you could fall into a “coverage gap” that makes you ineligible for Medicaid or subsidies for marketplace plans. 

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What Is Your Income Limit for Medicaid in Florida?

The Florida Department of Children and Families (DCF) offers resources to help you determine your income limit for Medicaid benefits. In addition, the Medicaid income examples listed below highlight the maximum monthly income limits for various groups:

• Pregnant women: Around $2,588 per month for a single person
• Children/families: Income limits vary, but they tend to be higher for young kids versus older children and parents
• Seniors/disabled (for long-term care): Around $2,829 per month for an individual, with special rules for spouses

Outside of these groups, standard adults (under 65, not disabled, not pregnant, not caring for kids) have no general coverage because Florida hasn’t expanded Medicaid. Consult with a Medicaid planning attorney to find out if you’re eligible for program benefits. Your lawyer can assess your income and, if warranted, guide you through the Medicaid application process. 

What Happens if You Don’t Meet the Income Limits for Medicaid?

If you earn more than the income limits for Medicaid, you will be ineligible for program benefits. However, in Florida and other states, “spend-down” programs can help you reduce your countable assets and meet the criteria for long-term care. 

For example, if your assets exceed Medicaid’s income limits, you may use the excess to pay for your non-covered medical needs or personal items until you fall within the allowed range. Alternatively, you may spend down the difference on medical care until your income matches the state’s “medically needy” income level, then Medicaid will cover the rest.

Those who take advantage of a spend-down program will need to do so in alignment with the five-year look-back period for Medicaid. With Medicaid, asset transfers are reviewed over the course of the last five years. If you give away or sell assets at below fair market value in the hopes of reaching the program’s income limits, you could be penalized for doing so. 

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What to Do if You Want to Apply for Medicaid But Your Income Exceeds the Program’s Limits

Speak with a lawyer who has relevant Medicaid planning experience. Your attorney can discuss Medicaid’s gifting rules and other program topics with you. Depending on your circumstances, they may advise you to use a Qualified Income Trust (Miller Trust) or Medically Needy Spenddown program to qualify for Medicaid. 

A Miller Trust allows you to put your income that exceeds Medicaid’s limit into a special trust, making you eligible for the program. Meanwhile, with a Medically Needy Spenddown, you can spend down your excess income by incurring medical bills. As soon as your medical expenses equal your excess income, you become eligible for Medicaid for the period these bills cover.

It can also be beneficial to look at Medicaid alternatives. For instance, if you’re 65 or older, you’ll likely qualify for Medicare, which has different rules from those of Medicaid. Or, if you have children, they may qualify for the Children’s Health Insurance Program (CHIP). 

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The Bottom Line on the Income Limits for Medicaid

Medicaid’s income limits can make it tough for you to capitalize on all that this program offers. Thankfully, you have access to legal help. If you have a Medicaid planning lawyer on your side, you can receive the guidance and support you need to help you obtain program benefits. 

The Siegel Law Group, P.A., has over 100 years of combined experience on staff. If you’re worried about Medicaid’s income limits and whether you’ll be ineligible for program benefits, we’re here to help. To get started, schedule a free consultation with us. 

Call or text 561-955-8515 or complete a Free Case Evaluation form