Who decides what
Three agencies split the work on every case. AHCA administers SMMC LTC, sets coverage policy, and enrolls approved individuals into a managed-care plan. DCF determines financial eligibility — income and assets. DOEA, through its Comprehensive Assessment and Review for Long-Term Care Services (CARES) program, determines medical eligibility: whether the applicant actually needs nursing-facility-level care. CARES runs 17 field offices statewide and the assessment is free (DOEA, CARES Program).
The three pillars every applicant must clear
- Medical/functional need: a CARES determination of nursing-facility level of care (or hospital level of care for cystic fibrosis) — codified at Fla. Stat. § 409.979(1).
- Income: generally capped at $2,982/month for an individual in 2026 — see the asset & income limits page.
- Assets: generally $2,000 countable for an individual, with protections for a spouse remaining at home — also on the asset limits page.
Income and asset limits are identical whether someone is pursuing nursing-home coverage or home-based waiver services — DCF's official standards table lists one combined "ICP/HCBS/Hospice" line for both (DCF Appendix A-9).
The one procedural difference that matters most: ICP (nursing home) applicants are processed on their own timeline with no capacity limit. Home and community-based services applicants must first be screened by an Aging and Disability Resource Center and may land on a statewide, frailty-ranked list before eligibility work even begins — see the
home care Medicaid page. This rule "is not applicable to Institutional Care Program (ICP) applicants" (
AHCA Rule 59G-4.193).
Where to start
Applications for financial eligibility are filed with DCF — online, or by phone at 1-866-762-2237. Home and community-based services applicants should start instead with the local Aging and Disability Resource Center or the Elder Helpline at 1-800-96-ELDER (1-800-963-5337) (AHCA, Become Eligible for Medicaid).
Not mutually exclusive. Most families combine two or three funding pillars — this one rarely stands alone.
The
Journey Assessment ranks all ten pillars against your specific situation and
recommends the top three.
