By Miami Senior Advisor Care Team · September 3, 2026
The fear behind almost every call we get
When a husband or wife in Miami-Dade, Broward, or Palm Beach first hears the words “nursing home Medicaid,” the question is almost never about paperwork. It is some version of this: If we apply, will I lose everything? Will I have to sell the house? Will I be left with nothing to live on?
The short answer is no. Federal law has protected the spouse who stays in the community since 1988, when Congress passed the spousal impoverishment provisions specifically to stop what was happening at the time — healthy spouses being stripped of savings and income before a sick spouse could get help. Florida applies those protections through the Department of Children and Families (DCF), which runs Medicaid eligibility, and the Agency for Health Care Administration (AHCA), which runs the Statewide Medicaid Managed Care Long-Term Care program (SMMC LTC).
The rules are real, but they are also technical, they change every January and July, and they are frequently misdescribed — including by staff at facilities who mean well. This guide walks through how Florida actually treats a married couple in 2026: what gets counted, what the community spouse gets to keep, how income is divided, and what to do first if you are in South Florida and this is landing on you right now.
One note before we start. Nothing here is legal advice, the figures below adjust on a schedule, and every household has details that change the math. Confirm your own numbers with DCF and, in most married cases, with a Florida elder-law attorney. Our help is free and separate from that — we do care placement, not legal work.
Two spouses, two labels: applicant and community spouse
Medicaid language splits a married couple into two roles. The spouse who needs care — in a nursing home, or receiving long-term care services in an assisted living community or at home through SMMC LTC — is the applicant spouse (you will also see “institutionalized spouse” on forms, even when the person lives in an ALF rather than a nursing home). The spouse who remains at home is the community spouse.
That distinction drives everything that follows. The applicant spouse faces strict limits: generally $2,000 in countable assets, and an income cap for institutional-level programs of $2,982 per month in 2026 (three times the federal SSI benefit rate). The community spouse faces neither of those limits. She or he is allowed to keep a protected share of the couple's assets and, in many cases, to receive part of the applicant's income as well.
Families routinely misunderstand this and start giving money away or retitling accounts long before anyone has counted anything. That is the single most expensive mistake in this whole area, because Florida looks backward five years at transfers. We wrote about that separately in our guide to the Florida Medicaid five-year look-back, and it is worth reading before you move a dollar.
The snapshot: how Florida counts a married couple's assets
Florida does not look at whose name is on which account. For the asset test, DCF pools everything the couple owns that is countable — his accounts, her accounts, joint accounts, brokerage, CDs, second properties, cash value in some life insurance policies — and treats it as one pile.
It then takes what is called a snapshot: a picture of that combined pile as of the first day of the first continuous period of institutionalization lasting at least 30 days. In practice, for most South Florida families, the snapshot date is the first day of the month a spouse entered a hospital and then went on to a rehab or nursing facility without going home in between. It is not the day you file the application, and it is not today. It can be months in the past.
This matters more than almost anything else in the process. The snapshot fixes the number the community spouse's allowance is measured against, and it means the couple's spending after that date does not change what was counted — though it very much changes what is left. If a spouse was admitted in March and you are only now looking at Medicaid in September, the March figure is the one DCF will want documented. Start pulling statements from that month now; banks in Miami are not fast, and requesting six months of records from three institutions can add weeks to an application.
The Community Spouse Resource Allowance in 2026
Once the pile is counted, the community spouse is allowed to keep a protected slice of it. That slice is the Community Spouse Resource Allowance, or CSRA.
For 2026, the federal figures set by the Centers for Medicare & Medicaid Services run from a minimum of $32,532 to a maximum of $162,660. These are calendar-year figures, effective January 1 through December 31, 2026, and they are adjusted every January.
Where states differ is in how they apply that range. Some states give the community spouse one half of the couple's countable assets, subject to the floor and the ceiling. Florida is more generous: it applies the maximum standard, meaning the community spouse may retain countable assets up to the federal maximum — not merely half — with the applicant spouse still needing to come down to roughly $2,000.
A concrete example. Suppose a Hialeah couple has $190,000 in combined countable assets at the snapshot. In a one-half state, the community spouse might be limited to about $95,000. In Florida, the community spouse can hold up to $162,660, and the remaining roughly $27,000 is what has to be dealt with before the applicant spouse qualifies. That difference — tens of thousands of dollars — is one of the more meaningful facts about retiring in this state, and it is routinely missed by families using national websites written for other states.
What happens to the excess above the CSRA is where planning lives. It does not have to be handed to a nursing home. Depending on the situation it may be spent on exempt items, used to pay off a mortgage, put toward an irrevocable funeral contract, or handled through a spousal annuity or other structure. Those moves are technical, they interact with the look-back, and they are exactly where an elder-law attorney earns the fee.
The house, the car, and what Florida never counts
The most common fear in South Florida — where the house is often the largest asset a family has — is that Medicaid will force a sale. Here is the actual rule.
The homestead is an exempt asset, meaning it is not counted at all, when the community spouse lives in it. Florida's home equity cap for 2026 is $752,000, but that cap applies only when no spouse or dependent relative is living in the home. If your husband is in a nursing home in Kendall and you are living in the house in Westchester, the equity in that house is not counted, whatever the Zillow number says. Given what South Florida property has done over the past decade, this single rule saves more families than any other.
Also generally excluded from the count: one vehicle, personal belongings and household goods, an irrevocable pre-need funeral contract, certain burial spaces and a small designated burial fund, and term life insurance with no cash value. Retirement accounts get complicated — Florida's treatment of an IRA depends on whose it is and whether it is in payout status — and that is another reason married cases are worth professional review.
Estate recovery is a separate question that families often merge into this one. Florida is required to seek recovery from the estates of certain Medicaid recipients after death, but it cannot recover while a surviving spouse is living, and Florida's constitutional homestead protections limit what can be reached afterward when the property passes to heirs. We cover that in more depth in Can Florida Medicaid take my parent's home?
Income: whose check is it, and the maintenance needs allowance
Assets and income are counted under completely different rules, and conflating them causes a lot of unnecessary panic.
For income, Florida follows the name-on-the-check rule. The community spouse's own Social Security, pension, annuity payments, and wages belong to the community spouse, full stop. They are not counted toward the applicant's income cap, and they do not have to be turned over to a facility. A wife in Coral Springs with a $2,400 monthly pension keeps that $2,400 regardless of what her husband's care costs.
The applicant spouse's income is treated differently. Once approved, most of it goes toward the cost of care — this is called patient responsibility — after certain deductions: a personal needs allowance, health insurance premiums including Medicare Part B, and, importantly, a diversion to the community spouse if the community spouse's own income is low.
That diversion is governed by the Minimum Monthly Maintenance Needs Allowance (MMMNA). It is a floor, not a ceiling. Effective July 1, 2026 through June 30, 2027, the federal minimum MMMNA is $2,705 per month in the 48 contiguous states and the District of Columbia. If the community spouse's own income falls below that figure, income from the applicant spouse can be shifted over to bring the community spouse up to it. An excess shelter allowance — for rent or mortgage, taxes, insurance, HOA fees, and a utility standard — can raise the calculated figure above the floor, which matters enormously in Miami-Dade and Palm Beach where housing costs are what they are. The maximum allowance for 2026 is $4,066.50 per month.
Separately, if the applicant spouse's own gross income exceeds the $2,982 monthly cap, Florida does not simply deny the case. The standard fix is a Qualified Income Trust, sometimes called a Miller trust, which must be established and funded correctly and in the right month. We walk through that in our guide to the Florida qualified income trust.
When the standard allowance is not enough
The published figures are defaults, not verdicts. Two escape valves exist, and both are underused.
The first is a fair hearing. If the standard CSRA does not generate enough income for the community spouse to reach the maintenance allowance — typically because the couple's assets produce little income — the community spouse can request a hearing to have additional assets protected. This is the mechanism sometimes called an expanded or increased CSRA, and it is fact-driven.
The second is a court order for spousal support. A Florida court can enter a support order that requires a larger diversion of income to the community spouse than the standard calculation produces, and Medicaid generally must honor it.
Neither is a do-it-yourself project, and neither is available retroactively once you have spent down assets you did not have to spend. That is the argument for getting advice early, while options still exist, rather than after the money is gone.
How this lands differently in assisted living versus a nursing home
Two families can hear the same rules and get very different outcomes, because the setting changes the math.
In a nursing home, Medicaid pays the facility, and the applicant's income (minus the deductions above, including any diversion to the community spouse) goes toward the cost. The community spouse protections apply in full. Our Miami nursing home overview covers how to compare facilities before this stage.
In an assisted living community, the picture is different and it surprises people. SMMC LTC can cover personal care and services in a participating ALF, but Medicaid does not pay room and board. The resident pays room and board from income, subject to a state-set cap, and the community spouse diversion still applies. The practical consequence is that the couple's combined income — not just assets — determines whether assisted living is even workable. Not every community in Miami, Fort Lauderdale, Boca Raton, or West Palm Beach holds a Medicaid contract with an SMMC plan, and among those that do, Medicaid-designated beds are limited and often waitlisted. Asking “do you accept Medicaid?” is not enough. Ask which plans they contract with, how many Medicaid beds they hold, and whether a private-pay period is required first — and get the answer in writing before anyone moves in.
Memory care sits inside assisted living licensure in Florida rather than being its own category, so the same room-and-board reality applies to secured memory care, usually at a higher private-pay rate.
What to do in the next 30 days if you are in South Florida
A practical order of operations, in the sequence that actually works:
1. Fix your snapshot date and gather statements from that month. Identify the first day of the qualifying continuous period of care and pull every account statement as of that date. This is the slowest step, so start it first.
2. Get the level-of-care determination moving. Financial eligibility is only half the test. The Department of Elder Affairs' CARES program has to determine that the applicant meets nursing-facility level of care. That review is a separate track from DCF and can be started in parallel.
3. Apply through ACCESS Florida. DCF handles the financial side through its ACCESS system. Married cases are the ones most often denied for documentation gaps rather than substance, so over-document.
4. Call your Aging and Disability Resource Center. Miami-Dade and Monroe are served by the Alliance for Aging; Broward by the Aging and Disability Resource Center of Broward County; Palm Beach and the Treasure Coast by the Area Agency on Aging serving that region. The statewide Elder Helpline is 1-800-963-5337, and SHINE volunteers provide free, unbiased Medicare and Medicaid counseling, in Spanish and Creole in this market.
5. Talk to a Florida elder-law attorney before restructuring anything. In a married case with assets above the CSRA, the fee is generally small relative to what is at stake, and the timing decisions are irreversible.
6. Line up the care itself in parallel. Approval without a bed is not a plan. Knowing which communities in your area actually take SMMC LTC, and where the wait is realistic, changes what you should be doing this month.
Where families lose money that they did not have to lose
After years of walking South Florida families through this, the same handful of avoidable losses come up again and again, and none of them involve the rules being unfair — they involve acting before understanding. The first is gifting: a parent transfers the house to a child, or moves $60,000 to a daughter “for safekeeping,” and creates a penalty period during the five-year look-back that leaves the family paying privately for months with money they have already given away. The second is spending down assets that never needed to be spent, because nobody told the community spouse that Florida applies the maximum CSRA rather than the one-half rule, so a couple burns through $70,000 of protected savings on private-pay care out of a belief they had to. The third is the reverse error — waiting. Families delay because the paperwork looks impossible, and each month of delay is another month of private-pay rates in a market where assisted living commonly runs $3,500 to $7,500 a month and skilled nursing runs far higher. The fourth is missing the income diversion entirely: a community spouse living on $1,600 a month of Social Security who was entitled to a transfer from her husband's pension, and simply never asked because no one at the facility mentioned it. And the fifth is choosing a community that says it takes Medicaid without confirming it holds a contract with the specific SMMC plan the applicant is enrolled in, which is a very different question. All five are preventable with a phone call made before the decision instead of after. Our advisors are free, we are local and bilingual, and we can tell you in one conversation which providers in your county actually work with SMMC plans — and when to bring in an elder-law attorney before, not after, the money moves. Our Florida resources hub and our guide to paying for senior care in Miami cover the funding picture more broadly, and the SMMC LTC eligibility walk-through covers the application itself in detail.