What Happens When Medicaid Isn't Enough to Cover Your Assisted Living Bill in Florida?
If you or a loved one is living in an assisted living facility (ALF) in Florida and receiving Medicaid benefits, you may have run into a frustrating reality: Medicaid doesn't always cover the entire bill. It's one of the most common concerns that comes up during Medicaid planning consultations — and it's worth taking a close look at why this happens and what your options actually are.
Nursing Facility vs. Assisted Living Facility: A Key Difference
Before getting into the details, it's important to draw a clear line between a skilled nursing facility and an assisted living facility in Florida, because Medicaid works very differently in each setting.
In a skilled nursing facility, Medicaid essentially has you covered. Your income — with the exception of a small personal needs allowance — goes directly to the facility, and Medicaid pays 100% of the remaining balance for at least a semi-private room. It doesn't matter whether your income is high or low. There is, in effect, zero financial deficit risk in a nursing facility under Florida Medicaid.
An assisted living facility is a different story entirely.
Why the Gap Exists in Assisted Living
An ALF bill in Florida typically has two components:
- Room and board (rent) — the housing portion of your stay
- Level of care — the medical and personal care services you receive
Add those two together and you get your total monthly ALF cost. Throughout Florida, that number typically ranges from around $3,000 on the low end to $6,000–$7,000 or more per month, depending on the facility and the level of care needed.
Here's where the problem comes in: Medicaid only pays the level of care portion of the bill. It does not cover the room and board portion. That means a Medicaid recipient's personal income plus what Medicaid contributes may not add up to the full amount the ALF charges — leaving a monthly deficit that has to be covered some other way.
This is the core issue, and it's one that catches a lot of families off guard.
What Can Be Done About the Deficit?
The good news is that there are several paths forward when a gap exists between what Medicaid pays and what the facility charges. They range from ideal to less ideal, but they're worth knowing about.
1. Medicaid Planning Before the Crisis Hits
The best time to deal with this problem is before it becomes a crisis. Through legal and ethical Medicaid planning strategies under Florida law, there are legitimate ways to protect assets so that a Medicaid recipient has funds available to supplement their care costs — whether that means covering any ALF deficit, paying for additional home care, or simply having a financial cushion for as long as possible.
The key is acting early. The longer you wait, the fewer options you have. But contrary to what many people believe, you don't have to wait five years, sell your home, or spend down everything before Medicaid can help pay for care. Proper planning can get you there much sooner while preserving assets that would otherwise be lost.
2. Family Contributions
When a monthly deficit is manageable — say, $500 per month — it's sometimes possible for family members to chip in and cover the difference. Split three ways, that's a little over $150 per person, which might be workable for some families. This isn't always an option, of course. Not every family has the financial flexibility to take on even a modest ongoing expense.
3. Negotiating with the Facility
This one surprises a lot of people, but it's a real option: you can negotiate directly with the assisted living facility. ALFs are not required to accept less than their full rate, but many are willing to work something out — especially if a resident has been there for a while, is a good fit for the community, and isn't creating operational headaches.
A facility might agree to accept $500 less per month, or split the difference on a $1,000 shortfall. It depends entirely on the relationship and the circumstances, but it's absolutely worth having that conversation before assuming the answer is no.
4. Finding a Less Expensive Facility
If the deficit can't be closed through family contributions or negotiation, the next option is to look for a less expensive ALF that accepts Medicaid. Florida Medicaid transfers relatively smoothly within the state, so switching facilities is administratively feasible.
That said, moving an elderly or disabled person is genuinely disruptive. People build routines, relationships, and a sense of comfort in their environment. Uprooting that carries real costs — even if it doesn't show up on a bill. And finding a facility with equivalent quality at a lower price isn't guaranteed. This option works, but it comes with tradeoffs.
5. Transitioning to a Skilled Nursing Facility
When nothing else works — when no family members can contribute, negotiation isn't possible, there's no less expensive ALF available or willing to accept the resident, and the quality of alternatives is unacceptable — the final option is transitioning to a skilled nursing facility.
This is often the recommendation that assisted living facilities themselves will make when a financial shortfall becomes unsustainable. And as discussed earlier, it's the one setting in Florida where Medicaid truly covers the full cost, regardless of income. It may not be the preferred outcome, but it does resolve the financial problem entirely.
The Bottom Line
The gap between what Medicaid covers and what an assisted living facility charges is a real and common problem in Florida. It doesn't have a single easy fix, but it does have solutions — and the earlier you plan, the more solutions you have available to you.
If you or a family member is currently in or considering an ALF, or if you're worried about what happens as savings start to run low, don't wait for a crisis to act. The options narrow significantly once money runs out.
Want to Protect Your Assets and Plan Ahead?
Elder Needs Law helps Florida families use legal, ethical strategies to qualify for Medicaid and protect assets — without waiting years or going broke first.
📘 Read the Book: Medicaid: How to Get the Government to Pay for Some of Your Long-Term Care Expenses — a practical guide written for Florida families facing long-term care decisions.
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The information in this article is provided for general informational purposes and does not constitute legal advice. Laws and programs referenced apply to the State of Florida. Please consult a qualified attorney for guidance specific to your situation.
