Disabled and Denied? Understanding Florida Medicaid’s Income vs. Asset Limits

Quick Summary: Many Florida seniors are shocked to be denied Medicaid even when their monthly income is low. If you live in Florida and receive less than $2,000 a month in Social Security but were still denied, the issue is likely not your income—it is your assets. Here is what you need to know about the "hidden" limits that trigger a denial.

If you are disabled, over 65, and living on a fixed income, receiving a denial letter from Florida Medicaid can be confusing and stressful.

A common scenario we see involves couples who get less than $2,000 a month combined in Social Security but still don't qualify. If this sounds like you, it is important to understand that Florida Medicaid looks at two distinct financial buckets: your Income and your Assets.

Passing one test does not mean you automatically pass the other.

1. The Income Test

First, the good news: If your combined household income is only $2,000 a month, income is likely not the reason for your denial.

In Florida, the income limit applies per individual.

• The state allows an individual to have a gross monthly income that does not exceed the set limit (often referred to as the "income cap").

• Important Note: Social Security is just one form of income. If you also receive a pension or any other type of incoming funds, those totals are included in this calculation.

However, since the limit is per person, a combined income of $2,000 typically falls well within the safety zone for eligibility.

2. The Asset Test (The Likely Culprit)

This is where most applicants get tripped up. Even if you are poor in terms of monthly income, you might be "rich" in terms of assets—at least according to Medicaid's strict definition.

Florida Medicaid has a separate Asset Limit that is completely independent of your income.

• The Rule: An individual is typically permitted to have no more than $2,000 in available assets.

• The "One Day" Rule: Your bank account generally must have no more than $2,000 in it at least one day out of the month after all bills are paid.

If your bank balance hovers above $2,000—even if you need that money for next month's bills—you could be disqualified for being "over asset."

What Counts as an Asset?

Medicaid looks at "available resources" that you could theoretically use to pay for care. These include:

• Cash or money in bank accounts

• Stocks and Bonds

• Mutual Funds

• Retirement accounts (if not handled properly)

• Cash surrender values of insurance policies

What Assets Are Allowed?

Not every dollar counts against you. There are specific exceptions you can utilize to reduce your countable assets:

• Irrevocable Life Insurance: Policies designated specifically for burial are often permitted.

• Separate Burial Fund: You are allowed to have a designated burial fund of up to $2,500, provided it is in a non-interest-bearing account.

• Medical Spending: You can "spend down" excess assets on medically necessary items or bills to reach the $2,000 limit.

3. Other Reasons for Denial (Paperwork Errors)

Sometimes, a denial has nothing to do with your actual finances and everything to do with the application itself.

• Incomplete Information: If the Department of Children and Families (DCF) does not receive the specific documents they asked for, or if the data isn't in the format they prefer, they may issue a denial based on "lack of information."

• Application Errors: If a facility applied on your behalf but didn't push the application through correctly, or if the forms were filled out improperly, you could be denied.

What To Do If You Are Denied

If you believe you meet both the income and asset limits but were still rejected, do not give up.

1. Read the Denial Letter: The letter will explain the specific reason DCF denied the application (e.g., "over asset," "lack of info").

2. Act Quickly: You typically have a window of time (often 30 days) to send in new information or correct the error to reverse the denial.

3. Consult an Elder Law Attorney: Medicaid rules are not simplistic. An attorney can review your denial letter, identify the trigger, and guide you on how to fix it—whether that means spending down assets correctly or simply fixing a clerical error.

Need Help with a Florida Medicaid Denial?

If you are in Florida and struggling with Medicaid eligibility, estate planning, or probate questions, we can help you make sense of the denial letter and get your application back on track. Schedule a Free consultation and lets start your Medicaid Planning today.