Florida Medicaid Rule Changes in 2025: Essential Insights for Florida Residents

For seniors and their families in Broward County, Florida, Medicaid is often a critical resource for long-term or in-home care. However, eligibility rules evolve, and staying informed is vital. At Horacio Sosa, P.A., a law firm with a Heart, we guide families through these complexities with clarity and care.

1. Real Medicaid Changes in 2025 You Should Know

a) Statewide Medicaid Managed Care (SMMC) 3.0 Launch

On February 1, 2025, the Florida Agency for Health Care Administration (AHCA) began implementing the Statewide Medicaid Managed Care (SMMC) 3.0 program. This overhaul includes new managed-care contracts, a reduced number of service regions (from 11 to 9), and upgraded provider networks. The Florida Senate+7Florida Health Admin+7Claim.MD+7

Nearly all Medicaid recipients — including those in Broward — have been automatically enrolled in a Managed Care Organization (MCO). It’s still possible to opt out or change your plan, but only within specific windows. Florida Health Justice+1

Moreover, SMMC 3.0 promises faster prior authorization decisions — now within 5 days, down from 7 — and improved care coordination, especially for behavioral and geriatric services. Florida Phoenix+5Florida Health Admin+5Florida Health Admin+5

b) Medically Needy Limits: What You Can Keep

• Medically Needy Income Limits (MNIL):

• $180/month for singles

• $241/month for married couples Politico+15Medicaid Planning Assistance+15KFF+15
  

• Asset Limits for Medically Needy:

• $5,000 for individuals

• $6,000 for married couples The Florida Senate+15Medicaid Long Term Care+15Elder Care Resource Planning+15Elder Care Resource Planning+1

For Nursing Home or HCBS (Home and Community-Based Services), income cannot exceed $2,901/month. For married applicants, only the applying spouse’s income is counted, and the non-applicant spouse may keep significant assets—up to $157,920—via the Community Spouse Resource Allowance (CSRA). Medicaid Planning Assistance+3Medicaid Long Term Care+3Elder Care Resource Planning+3

Florida maintains a 60‑month Look‑Back Period to review asset transfers and prevent eligibility manipulation. Medicaid Long Term Care

c) Enhancing Waiver Services for Medically Fragile Children

House Bill 1085 (effective July 1, 2025) shifts the administration of the Children’s Medical Services (CMS) Managed Care plan from the Department of Health to AHCA. It also mandates a redesigned Medicaid Model Waiver featuring tiered services to support children needing private-duty nursing, with an evaluation plan due by January 15, 2028. The Florida Senate

2. Why Being Proactive Matters More Than Ever

Medicaid planning is about more than eligibility—it’s about strategic protection. Effective planning can help avoid financial depletion due to unexpected care costs or policy changes. Common tools include:

• Qualified Income Trusts (Miller Trusts) to bypass income caps

• Asset exemptions like home equity, personal belongings, and funeral trusts

• Trusts or deed planning to navigate the Look‑Back Period and Medicaid Estate Recovery

Knowing what options exist—and acting early—can safeguard your financial stability and peace of mind.

3. Why Choose a Board-Certified Elder Law Attorney?

Horacio Sosa, Esq. brings:

• Over 20 years of experience in elder law, tax, and estate planning

• Board certification by the Florida Bar in Elder Law

• Bilingual fluency (Spanish/English) with deep cultural competence

• A local, compassionate approach tailored to Broward’s diverse community

Your legal strategy should align with your family's values and goals—not a one-size-fits-all solution.

4. What You Can Do Next

1. Review your SMMC 3.0 enrollment: Understand your plan, and use your initial 120-day window or annual open enrollment to make changes.

2. Know your financial limits: Ensure your income and assets align with current thresholds.

3. Schedule a planning session: Explore trusts, exemptions, and strategies to safeguard your estate.

4. Stay informed: Watch for policy shifts—state laws, federal funding changes, or waiver updates can impact your eligibility.
   

5. Ready to Take the Next Step?

If you're beginning Medicaid planning or adapting to 2025 updates, now is the time to act. Let us help you build a plan grounded in clarity, compassion, and confidence.

Contact Horacio Sosa, P.A. today for your consultation—and move forward with certainty.

Sources

• Florida Agency for Health Care Administration (AHCA) – Statewide Medicaid Managed Care (SMMC) 3.0 Overview
  ahca.myflorida.com

• AHCA Presentation Deck (May 2025) – Statewide Medicaid Managed Care 3.0 details, including prior authorization changes
  Download PDF

• Florida Health Justice Project – Continuity of care requirements and managed care enrollment updates
  floridahealthjustice.org

• Florida Medicaid Managed Care Program (Official FAQ) – Enrollment, opt-out, and plan change rules
  flmedicaidmanagedcare.com

• Medicaid Planning Assistance – Florida Medicaid income and asset eligibility limits
  medicaidplanningassistance.org

• Medicaid Long-Term Care Resource – Income limits, asset allowances, community spouse protections, and look-back period
  medicaidlongtermcare.org

• Florida Senate – Bill Analysis (HB 1085, 2025 Session) – Children’s Medical Services and Medicaid Model Waiver redesign
  flsenate.gov