How Much Do I Pay the Nursing Home if My Parent is on Medicaid in Florida?

Attorney Kellen Bryant explains how Florida Medicaid calculates what families must pay toward nursing home costs and what income your parent can keep.

When your parent qualifies for Medicaid to help pay for nursing home care, you might think all costs are covered. However, Medicaid requires your parent to contribute most of their income toward their care costs. Understanding how this calculation works can help you plan and budget for ongoing expenses.

Understanding Key Terms

Before diving into the calculation, it’s important to understand the terminology you’ll encounter:

• Patient Responsibility – The amount your parent must pay toward nursing home costs
• Patient Share of Cost – Another term for the same concept
• Gross Income – Total income before any deductions
• Personal Needs Allowance – The small amount your parent can keep for personal expenses

These terms all relate to how much of your parent’s income goes to the nursing home versus how much they can keep for personal use.

The Basic Formula

Calculating your parent’s nursing home payment follows a straightforward formula:

Gross Income – Allowable Deductions = Patient Responsibility (Amount Paid to Nursing Home)

Let’s break down each part of this calculation.

Step 1: Calculate Total Gross Income

First, you’ll need to determine your parent’s total gross income from all sources.

What Counts as Gross Income:

• Social Security benefits – The full amount before Medicare deductions
• Pension payments – Complete monthly pension amounts
• Other retirement income – 401(k) distributions, IRA withdrawals, etc.
• Investment income – Interest, dividends, rental income

Important: Use Gross Amounts

You must use the top-line gross amount before any deductions for:

• Medicare premiums
• Health insurance premiums
• Tax withholding
• Any other automatic deductions

Where to find this information: Check Social Security statements, pension statements, and other income documentation you receive at the beginning or end of each year.

Step 2: Subtract Allowable Deductions

Medicaid law permits your parent to keep certain amounts from their income before paying the nursing home.

Primary Allowable Deductions:

1. Health Insurance Premiums

Your parent can keep enough income to pay for:

• Medicare supplement insurance premiums
• Private health insurance premiums
• Medicare Part B and Part D premiums

2. Personal Needs Allowance

This is a set amount your parent can keep each month for personal expenses.

Current Amount: $105 per month (as of the time of this writing)

Recent Change: This was recently increased from $35 per month in Florida

What the Personal Needs Allowance Covers:

Your parent can use their $105 monthly allowance for:

• Beauty parlor or barbershop services
• Medical co-pays and deductibles
• Over-the-counter medications
• Personal care items (deodorant, soap, shampoo)
• Snacks and comfort foods
• Small personal purchases
• Entertainment or activities

Step 3: Calculate Patient Responsibility

After subtracting the allowable deductions from gross income, the remaining amount becomes your parent’s “patient responsibility”—the amount they must pay to the nursing home each month.

Example Calculation:

Gross Monthly Income: $2,500
Less: Health Insurance Premium: -$150
Less: Personal Needs Allowance: -$105
Equals: Patient Responsibility: $2,245 per month to nursing home

What This Means for Your Family

Understanding this calculation helps you realize that:

• Most income goes to care costs – Your parent contributes the majority of their income toward nursing home expenses
• Medicaid covers the difference – The nursing home’s total cost minus your parent’s contribution is paid by Medicaid
• Personal funds are very limited – Only $105 monthly remains for all personal needs and wants
• Health insurance premiums are protected – Essential coverage can be maintained

Important Considerations

The Calculation Changes with Income

If your parent’s income changes (Social Security increases, pension adjustments, etc.), their patient responsibility will change accordingly.

Additional Deductions May Apply

In some cases, other deductions might be allowed, such as:

• Spousal support allowances (if married)
• Dependent family member allowances
• Home maintenance expenses (if returning home is planned)

Regular Reviews Are Required

Medicaid periodically reviews your parent’s financial situation, which may result in adjustments to their patient responsibility amount.

Planning Implications

This calculation system has several implications for families:

• Very little discretionary income remains – Plan accordingly for any additional needs or wants
• Health insurance becomes even more important – Since premiums are deductible, maintaining good coverage is wise
• Advanced planning can help – Proper estate planning may help preserve more assets for family members

Getting Professional Help

While the basic calculation is straightforward, individual situations can be complex. Factors that might affect your parent’s patient responsibility include:

• Spousal considerations
• Complex income sources
• Special medical needs
• Asset protection strategies

Working with an elder law attorney can help ensure you understand all applicable rules and optimize your parent’s situation within Medicaid guidelines.

For guidance specific to your parent’s Medicaid situation and nursing home costs, consult with experienced elder law professionals who understand Florida’s Medicaid rules and can help you navigate this complex process.