Nursing home care in Florida averages more than $10,000 per month - and rising. For a married couple, even a moderate stay can wipe out a lifetime of savings. The good news: with proper planning, much of your estate can be protected. Here are the most common legal strategies Florida families use to plan for the cost of long-term care.
Why Long-Term Care Planning Matters
Medicare does not pay for long-term nursing home care beyond a brief rehabilitation period. Private long-term care insurance is expensive and increasingly hard to obtain. That leaves two realistic options for paying:
- Out of pocket, until savings are gone
- Florida Medicaid, which has strict financial eligibility rules
The strategies below help you qualify for Medicaid sooner - while preserving as much of your estate as possible for your spouse and family.
Strategy 1: The Five-Year Plan (Irrevocable Trusts)
Florida Medicaid examines all asset transfers made during the five years before you apply. Anything you gave away during that period can trigger a penalty period of ineligibility.
But after five years, those transfers are no longer counted. This is the foundation of long-range planning:
- Place assets into a properly drafted irrevocable Medicaid asset protection trust
- Wait at least five years
- The assets are protected, you can still receive income from them, and you preserve them for your heirs
The key word is "properly drafted" - the trust must follow specific rules to work. A homemade trust will not.
Strategy 2: Spousal Protection (CSRA)
When one spouse needs nursing home care and the other does not, federal Medicaid law provides important protections for the community spouse (the one staying home):
- The community spouse can keep a Community Spouse Resource Allowance (currently around $154,000)
- The community spouse can keep the home (regardless of value)
- One vehicle is exempt
- A monthly maintenance income allowance protects the community spouse from impoverishment
With proper planning, additional assets can often be shifted into protected categories, allowing the at-home spouse to keep substantially more.
Strategy 3: Personal Services Contracts
Florida allows a family member to be paid for caregiving services through a written personal services contract. Done correctly, this:
- Compensates a family member who is already providing care
- Reduces countable assets (the lump sum is treated as a fair-market payment, not a gift)
- Avoids the five-year transfer penalty
This must be set up before services are provided, with clear hourly rates and documentation.
Strategy 4: Qualified Income Trusts (QITs)
Florida is an income cap state. If your monthly income exceeds the limit (currently around $2,829), you cannot qualify for nursing home Medicaid - unless you place excess income into a Qualified Income Trust, sometimes called a Miller Trust.
The QIT doesn't reduce what you actually pay toward care, but it allows you to qualify for Medicaid coverage of the rest. Without it, families above the income limit are simply locked out.
Strategy 5: Spend-Down on Exempt Assets
Not all assets count for Medicaid. Before applying, families can convert countable assets into exempt ones:
- Pay off the mortgage
- Make needed home repairs or accessibility improvements
- Replace an aging vehicle
- Prepay funeral expenses through an irrevocable funeral trust
- Pay outstanding debts
Done strategically, spend-down can dramatically reduce countable assets without "wasting" a dollar.
When to Start Planning
The earlier, the better. Five-year planning requires, well, five years. But it's never too late - even on the eve of a nursing home admission, "crisis planning" strategies (spousal transfers, personal services contracts, exempt-asset conversions) can still preserve significant assets.
The Takeaway
Long-term care planning isn't about hiding assets or gaming the system - it's about using laws Congress wrote to protect families from financial devastation. The earlier you plan, the more options you have.
At Zacharia Frey PLLC, we help Southwest Florida families navigate Medicaid planning with strategies tailored to their situation. Contact us for a consultation to learn what's possible in your case.
Frequently Asked Questions
How much does a Florida nursing home cost in 2026?
Florida nursing home care averages over $10,000 per month in 2026, with private rooms running $12,000-$15,000+ in many parts of Southwest Florida. The cost has risen sharply in the last several years and continues to climb. A single year of care can easily exceed $130,000 - and average stays last 2-3 years. For couples, the cost can wipe out a lifetime of savings in 18-24 months.
Does Medicare pay for long-term nursing home care?
No. Medicare pays for only short-term rehabilitative stays - up to 100 days following a hospitalization, and only if you continue to make medical progress. Once you stop progressing or hit the 100-day cap, Medicare ends. For ongoing custodial care, you must pay privately, use long-term care insurance, or qualify for Medicaid.
Can I keep my house if I apply for Florida Medicaid?
Generally yes - your primary residence is exempt from Medicaid's countable asset limits regardless of value, as long as you intend to return home or your spouse, dependent child, or disabled child lives there. However, after death, Florida's estate recovery program can place a lien on the home to recover Medicaid expenses. Proper planning (often involving a Lady Bird deed or irrevocable trust) can protect the home from estate recovery.
How much can the healthy spouse keep when the other goes into a nursing home?
The 'community spouse' (the one staying home) can keep the Community Spouse Resource Allowance (CSRA), currently around $154,000 in countable assets, plus the home, one vehicle, household belongings, and an irrevocable funeral trust. The community spouse is also entitled to a Minimum Monthly Maintenance Needs Allowance of income from the institutionalized spouse if their own income is insufficient. With proper planning, additional assets can often be shifted into protected categories.
What is a Qualified Income Trust (QIT) and do I need one?
Florida is an income cap state for nursing home Medicaid. If your monthly income exceeds the limit (currently around $2,829), you're disqualified - unless you place the excess into a Qualified Income Trust (also called a Miller Trust). The QIT doesn't reduce what you actually pay toward care, but it makes you eligible for Medicaid coverage of the rest. Without a QIT, families above the income limit are simply locked out of Florida Medicaid.
Can I just give my assets to my children to qualify for Medicaid?
No - this is the most expensive Medicaid mistake families make. Any uncompensated transfer in the five years before your application creates a penalty period of ineligibility. Worse, your children may face capital gains tax, divorce-related claims, or financial problems that put your money at risk. Proper Medicaid planning uses legal structures (irrevocable trusts, personal services contracts, exempt asset conversions) - not informal gifts.
Is it too late to plan if my parent is already in a nursing home?
No. Even on the eve of admission, crisis planning strategies can preserve significant assets - spousal transfers, personal services contracts, exempt asset conversions, and Medicaid-compliant annuities all remain available. The amount you can save is often substantial, even with no advance planning. The sooner you call an elder law attorney after the diagnosis or admission, the more options remain on the table.
What's the difference between Medicare and Medicaid for long-term care?
Medicare is health insurance for people 65+ regardless of income, but it pays only for short-term skilled care, not custodial nursing home care. Medicaid is a needs-based program that pays for long-term custodial care, but only after you spend down to strict asset and income limits. Most families confuse the two and assume Medicare will cover the nursing home - it won't. Medicaid is the only government program that pays for long-term care.
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