Medicaid Lawyer in Florida: What They Do and When You Actually Need One

What Does a Medicaid Lawyer Actually Do?

In my practice, families usually come to me at one of two moments: either a parent has just been told they need nursing home care, or an adult child is trying to plan ahead before that crisis hits. In both situations, the goal of a Medicaid lawyer is the same — get a loved one qualified for Florida Medicaid long-term care benefits as efficiently as possible, without unnecessarily giving up the family home or a lifetime of savings.

A Florida elder law attorney handling Medicaid matters typically:

• Reviews income and assets to determine current eligibility under Florida's rules
• Restructures countable assets into exempt or protected forms using legally recognized planning tools
• Prepares a qualified income trust (sometimes called a Miller Trust) when a person's income is too high to qualify but not enough to privately pay for care
• Prepares and files the actual Medicaid application with the Department of Children and Families
• Handles appeals and fair hearings if an application is denied
• Plans ahead of time to reduce exposure to Florida's Medicaid estate recovery program after death

This is not paperwork you want to guess at. Under Florida law, Medicaid planning is considered the practice of law, and the Florida Supreme Court has made clear that only a Florida Bar-licensed attorney may provide this advice — someone who is not a licensed attorney offering Medicaid planning guidance can be committing a felony under Florida Statute § 454.23. That protection exists for a reason: a poorly structured transfer or gift can cost a family months, sometimes years, of otherwise-available benefits.

Florida Medicaid Eligibility Rules for 2026

To qualify for Florida Medicaid long-term care — whether in a nursing home or through a home and community-based waiver — an applicant generally must meet both an income test and an asset test. For 2026, the commonly cited figures are:

• Income cap: approximately $2,901 per month for an individual applicant
• Countable asset limit: $2,000 for a single applicant
• Community Spouse Resource Allowance: the healthy spouse at home may generally retain up to roughly $157,920 in countable assets

Certain assets are exempt and don't count against the $2,000 limit, including the primary homestead (up to certain equity limits), one vehicle, and prepaid burial or funeral arrangements. Florida's homestead protections under Article X, Section 4 of the Florida Constitution work alongside these Medicaid rules, but they are not identical concepts — a home can be exempt for Medicaid eligibility purposes while still being subject to estate recovery after death if proper planning wasn't done.

These dollar figures adjust periodically, so I always confirm the current numbers before finalizing a plan rather than relying on last year's figures.

The Five-Year Look-Back Period: Why Timing Matters

This is the single most misunderstood part of Medicaid planning. Florida Statute § 409.9101 establishes a 60-month (five-year) look-back period on the Medicaid application. That means when you apply, the state reviews the prior five years of financial records for gifts, transfers, or asset moves made for less than fair value.

If a disqualifying transfer is found, Medicaid doesn't just deny the application — it imposes a penalty period, calculated by dividing the value transferred by a state-set penalty divisor (a figure that itself changes periodically). During that penalty period, Medicaid will not pay for care, even though the applicant otherwise qualifies.

This is exactly why elder law attorneys talk about planning early. A properly structured irrevocable trust or asset transfer completed well outside the five-year window generally avoids look-back penalties entirely, while the same transfer done during a health crisis can backfire badly.

What Happens to the House? Estate Recovery Explained

Many Florida families' biggest fear is losing the family home. Here's the honest answer: while a home is generally an exempt asset for Medicaid eligibility purposes while the recipient is alive, Florida's Medicaid Estate Recovery Program allows the Agency for Health Care Administration to seek reimbursement from the recipient's probate estate after death for benefits paid during their lifetime.

The key word is probate. Florida's estate recovery is generally limited to assets that pass through the probate process. This is precisely why proper Medicaid and estate planning often go hand in hand — using tools like a properly drafted revocable trust under Florida Statute Chapter 736, an enhanced life estate deed, or other planning strategies can, in the right circumstances, keep the home out of the probate estate and outside the reach of estate recovery. Whether a particular strategy works depends heavily on the family's specific facts, including how the homestead devise rules under Florida Statute § 732.4015 interact with the estate plan.

Crisis Planning vs. Long-Term Planning

What I tell Florida clients is that there are really two different conversations, and a good Medicaid lawyer should be comfortable having both:

• Long-term planning: Done years before care is needed, using irrevocable trusts, gifting strategies, and asset restructuring that fully clears the five-year look-back window with no penalty risk.
• Crisis planning: Done when a loved one needs nursing home care now or very soon. Even here, legitimate strategies exist — including spend-down techniques, qualified income trusts, and exempt asset conversions — that can accelerate eligibility without violating look-back rules, because not every legal transaction during the five-year window triggers a penalty.

The difference between a good outcome and a costly mistake is almost always the quality of the legal advice at the moment a family starts planning — whether that's five years out or five days out.

This article is for general informational purposes only and does not constitute legal advice, nor does reading it create an attorney-client relationship. Florida estate, elder, probate, and real estate law are fact-specific and change over time. Consult a licensed Florida attorney about your individual circumstances. Arthur Simpson, Esq. is licensed to practice law in the State of Florida. Attorney advertising.