Caring for a loved one who depends on Medicaid can be complicated. Rules change, programs shift, and it is not always clear what applies to your family. One area that families may not be familiar with is Section 1115 Medicaid waivers, which can provide additional options and flexibility.
Section 1115 waivers give Florida the flexibility to try new ways to deliver care and support families. Some of these approaches fall outside standard federal Medicaid rules.
In 2026, these waivers matter more than ever. Florida is expanding support for family caregivers and considering fewer annual redeterminations for those with permanent disabilities. Staying informed protects access to doctors, home care, and vital financial support.
Understanding Section 1115 Medicaid Waivers
A Section 1115 Medicaid waiver is best thought of as special permission from the federal government. It allows Florida to use Medicaid funding in ways not usually permitted under standard federal rules.
In Florida, the most critical example is the Statewide Medicaid Managed Care program, commonly known as SMMC. This waiver lets the state require most Medicaid recipients to enroll in managed care plans. These plans coordinate medical services, manage costs, and streamline care delivery.
Three Major Changes for Families in 2026
In 2026, Florida is updating Medicaid in ways that affect families caring for aging or disabled loved ones. Here’s what you need to know:
Family Home Health Aide Pilot
Certain family members can now train as home health aides. They can also receive payment for their work. This change helps families keep care in the home while ensuring their loved ones get the support they need.
Expanded Lifelong Eligibility Efforts
Florida has submitted a waiver amendment to permanently exempt individuals with severe disabilities from the annual Medicaid redetermination process. Federal approval is still pending and not yet finalized.
Regional Consolidation
The state is reducing its Medicaid managed care regions from 11 to 9. Some health plans may merge or change names. It’s essential to check your provider network to ensure your doctors and services remain covered.
2026 Financial Thresholds
Eligibility for Medicaid waiver programs, especially the Long-Term Care (LTC) Waiver, is subject to strict income and asset limits. The state updated these limits on January 1, 2026. Key thresholds for a single applicant include:
- Monthly income: $2,982
- Includes Social Security, pensions, and other sources of income.
- Countable assets: $2,000
- Excludes one home and one vehicle.
- Spousal resource allowance (CSRA): $162,660
- The amount a non-applicant can keep while the other receives care.
- Home equity limit: Around $752,000
- Adjusted annually for inflation.
If your income exceeds $2,982, you may still have options. Florida allows the use of a Qualified Income Trust, also called a Miller Trust, to regain eligibility. You must set the trust up correctly and follow all Medicaid rules.
How Waivers Affect Your Care Access
Home and Community‑Based Services (HCBS)
This Medicaid waiver helps support care at home rather than in a facility. The Long‑Term Care Waiver has limited slots and is not guaranteed. Even if you qualify, there may be a waiting period.
Managed Care Requirements
Almost all Florida Medicaid recipients must enroll in a Managed Medical Assistance (MMA) plan. In 2026, families should pay attention to:
- Prior Authorization: Managed care plans review home health care hour requests and care plans. Understanding plan rules can help avoid delays in approved services.
- Network Changes: With regional restructuring and plan changes, check that your doctors and preferred facilities remain in‑network for 2026 to maintain continuity of care.
Action Plan: Steps to Protect Your Coverage
To avoid coverage gaps or surprise denials, Florida families should focus on these three steps:
- Audit Your Assets: Check your bank accounts and other countable assets to ensure they haven’t exceeded the $2,000 limit. Confirm your monthly income is within Medicaid limits ($2,982 for a single applicant).
- Check Your MyACCESS Account: Florida is still updating its Medicaid rolls following the public health emergency. Keep your contact information up to date to avoid missing essential redetermination notices.
- Review Legal Documents: Confirm that your power of attorney includes specific Medicaid planning authority. Without the correct language, your representative cannot create the trusts needed to qualify for the waiver.
Questions About Section 1115 Medicaid Waivers
Do waivers apply automatically?
Yes. Once approved, the state covers all qualifying Floridians. You only need a Managed Care Plan to access services.
Can waivers change mid-year?
Yes. AHCA can update, extend, or adjust waivers through a formal legal process.
Do waivers affect current recipients?
Yes. Changes often impact recipients during annual redetermination. Keep your MyACCESS information up to date to avoid coverage gaps.
How can families stay informed?
Check AHCA public notices, your Managed Care Plan’s Member Handbook, or consult a Medicaid planner.
Plan Early to Prevent Coverage Gaps
Early preparation is key to protecting yourself and your loved ones. Reviewing eligibility, updating documents, and planning care now can prevent gaps and give your family peace of mind.
The Scott Law Offices can help you navigate the process and ensure everything is in place. Schedule a consultation today to plan with confidence.
