The Current Situation
Where does the person needing care live right now?
Select… At home, independently At home, with family or paid caregivers Assisted living facility Nursing home or rehab facility Hospital
How urgent is this?
Select… Planning ahead — no immediate care need Care will likely be needed within a year Care is needed now Already in a facility — Medicare rehab coverage ending soon Already private-paying a facility
Health situation, in your own words
Diagnoses if known (for example dementia, stroke, Parkinson's), recent hospitalizations, and what changed recently.
Monthly Income
Florida Medicaid has an income cap, and income over the cap can usually be solved with a Qualified Income Trust, so exact figures matter less than the overall picture.
Approximate total gross monthly income (person needing care)
Select… Under $1,500 $1,500 – $3,000 $3,000 – $5,000 Over $5,000 Not sure
Spouse's approximate monthly income (if married)
Select… Under $1,500 $1,500 – $3,000 $3,000 – $5,000 Over $5,000 Not applicable
Exempt Assets
Florida does not count certain assets toward the $2,000 limit. These questions tell us what is already protected.
Does the person needing care own their home?
Select… Yes, owned outright Yes, with a mortgage Yes, jointly with spouse Yes, jointly with a child or other family In a life estate or trust No home owned Not sure
Approximate home value (if owned)
Select… Under $300,000 $300,000 – $600,000 $600,000 – $1 million Over $1 million No home owned
Vehicles owned
Select… None One Two or more
Prepaid burial or funeral arrangements?
Select… Yes No Not sure
Retirement Accounts & Annuities
In Florida, a retirement account that is in regular payout status is generally treated as an income stream rather than a countable asset, so how and how often withdrawals are taken matters more than the balance.
Does the person needing care have an IRA, 401(k), 403(b), or similar account?
Select… Yes No Not sure
Approximate total value of those accounts
Select… Under $50,000 $50,000 – $150,000 $150,000 – $500,000 Over $500,000 Not applicable
Are withdrawals currently being taken?
Select… No withdrawals yet Yes, required minimum distributions (RMDs) only Yes, regular withdrawals beyond RMDs Yes, occasional or irregular withdrawals Not sure
Withdrawal frequency
Select… Monthly Quarterly Annually Irregular Not applicable
Spouse's retirement accounts (if married)
Select… None Yes, no withdrawals yet Yes, taking regular withdrawals Yes, occasional withdrawals Not applicable
Any annuities?
Select… No Yes, in payout status (receiving regular payments) Yes, deferred (not paying out yet) Not sure
Countable Assets
These are the assets Medicaid counts toward the $2,000 limit. Checking a box does not mean the asset is lost; most can be lawfully repositioned or protected with the right design.
Total cash value of life insurance
Select… None / term insurance only Under $2,500 $2,500 – $25,000 Over $25,000 Not sure
Approximate total countable assets (excluding home and retirement)
Select… Under $50,000 $50,000 – $150,000 $150,000 – $500,000 $500,000 – $1 million Over $1 million Not sure