What happens to Florida Medicaid if the spouse at home dies first?

While both spouses are alive, Florida lets the spouse at home keep up to $162,660 in countable assets in 2026, plus the home, a car, and other exempt property, and a monthly income of at least $2,705 (see the community spouse guide). That protection comes from federal spousal-impoverishment law (42 U.S.C. § 1396r-5) and exists for the spouse who is still at home.

When that spouse dies, the protection has nothing left to protect. Whatever passes to the spouse in the nursing home becomes theirs, and they are now a single Medicaid recipient with a $2,000 limit.

Usually without anyone deciding that it should:

• The will. Most married couples' wills leave everything to the other spouse.
• Joint ownership. Joint bank accounts with right of survivorship, and a home owned as tenants by the entireties, pass to the surviving spouse automatically, outside the will.
• Beneficiary designations. IRAs, 401(k)s, annuities, and life insurance usually name the spouse.
• Payable-on-death and transfer-on-death accounts that name the spouse.
• No will at all. Under Florida's intestacy law a surviving spouse takes all or half of the estate, depending on the family.

Each of these can be fine while both spouses are healthy and a serious problem once one of them is on Medicaid.

The inheritance is a countable asset of the spouse in the nursing home (ESS Policy Manual, chapter 1600). It has to be reported to DCF, and Medicaid stops paying until it is spent down to $2,000, usually on the nursing home at roughly $10,645 a month.

The house needs separate attention. If it passes to the spouse in the nursing home, it can stay exempt while that spouse intends to return to it, but the $752,000 equity limit now applies, because the spouse who lived there and kept the limit from applying is gone.

The monthly income picture changes too. The income that was being diverted to support the spouse at home stops, and more of the nursing home spouse's income goes to the facility.

Not entirely. Florida does not allow a spouse to be disinherited. A surviving spouse is entitled to an elective share equal to 30 percent of the elective estate, a measure that reaches well beyond the probate estate and includes many assets that pass outside the will. Federal Medicaid law counts as an asset anything a person is entitled to but does not receive because of their own action or the action of someone acting for them (42 U.S.C. § 1396p(h)(1)). So the spouse in the nursing home, or an agent or guardian acting for them, usually cannot simply decline the share after the death without it being treated as a transfer.

This can be planned for. How the will, the elective share, and the couple's other assets are arranged so that the spouse in the nursing home is provided for without losing Medicaid is specific Florida legal drafting, and it is work for an elder law attorney, done while the spouse at home is still well.

As soon as one spouse is in a nursing home or applying for Medicaid:

• The healthy spouse's will. Does it leave everything outright to the spouse in care?
• Every beneficiary designation: IRAs, 401(k)s, annuities, life insurance, and payable-on-death or transfer-on-death accounts.
• How the home and the accounts are titled, especially joint accounts and a home held by the entireties.
• Who acts for the spouse in care if the healthy spouse dies. The healthy spouse is often the agent under the other's power of attorney and health care surrogate designation; a successor should be named and should know it.

Gathering this list is part of the application work. Changing a will, a deed, or a trust is legal work.

When we prepare a married couple's application, we ask how the healthy spouse's estate would pass, and we flag the wills, titles, and beneficiary forms that would leave assets to the spouse in care. The fix is done by Zacharia Frey PLLC under a separate engagement, or by any elder law attorney you choose. Start your free Medicaid assessment or call (239) 977-5175.

Adapted from Chapters 18 and 20 of Florida Long-Term Care and Medicaid (2026 Edition), by Carl B. Zacharia, with the figures updated to the ones Florida applies today.

• 42 U.S.C. § 1396r-5 — Treatment of income and resources for certain institutionalized spouses
• DCF ESS Policy Manual, Chapter 1600 — Assets (includes the transfer/look-back rules, 1640.0600 et seq.)
• Florida Statutes § 732.2065 — Amount of the elective share
• DCF Appendix A-9 — SSI-Related Programs Financial Eligibility Standards