Page 8 - Florida Long-Term Care Medicaid Post Approval Client Guide

Family First Firm • Florida Medicaid Post-Approval Guide

5. Waiver vs. ICP: Billing and Patient Liability

The way your income is handled differs significantly depending on whether you are in the
Institutional Care Program (ICP/Nursing Home Medicaid) or the Long-Term Care Waiver
program.

ICP (Nursing Home Medicaid)
If you are in a nursing home on ICP Medicaid, you have a "Patient Responsibility" or "Patient
Liability." This is the amount you must pay each month toward your care.

Calculation: Your gross monthly income MINUS the following deductions equals your patient
responsibility:
Personal Needs Allowance (PNA): $160 per month (this is money you keep for personal
1
expenses)

Health Insurance Premiums: Any supplemental insurance premiums you pay
Spousal Diversion (if applicable): If you have a spouse at home who needs additional
income support, some of your income may be diverted to them.

Example: John has $2,500/month in income. His patient responsibility is: $2,500 - $160 (PNA) -
$185 (Medicare supplement) = $2,155 paid to the nursing home each month.

LTC Waiver (In-Home, Adult Daycare, or Assisted Living)
If you are on the Long-Term Care Waiver receiving services at home or in an assisted living
facility, the billing works differently. You keep all of your income to pay for your living expenses,
including room and board if in an assisted living facility. Medicaid contributes toward the cost
of care services (typically $1,500-$1,900/month for ALF residents) but does NOT pay for room
2
and board.

Important for ALF Residents: Your income plus the Medicaid contribution may not cover the

full cost of the assisted living facility. You or your family may need to make up any difference
between your income, the Medicaid contribution, and the facility’s charges.

1 As of 2026, which may be adjusted.
Page 8 of 18 2 As of 2026, which may be adjusted.