Florida Assisted Living Waiver and In Home Care Medicaid Waiver Information and Rules for 2017

Introduction

Florida provides long-term care resources to seniors through the Florida Department of Elder Affairs (DOEA). Some of the many programs administered by DOEA include: Adult Care Food Program; Alzheimer’s Disease Initiative; Community Care For the Elderly (CCE); Comprehensive Assessment & Review for Long-Term Care Services (CARES); Congregate Meal and Nutrition Sites; Elder Farmers Market Nutrition Program; Emergency Home Energy Assistance Program (EHEAP); Health & Wellness; Home Care for the Elderly (HCE); Memory Disorder Clinics; National Family Caregiver Support Program; Nutritional Education for Older Adults; Nutrition Programs; Nutrition Services Incentive Program; Older Americans Act (OAA); Respite for Elders Living in Everyday Families (RELIEF); Senior Companion Program; Supplemental Nutrition Assistance Program

Additional programs tailored for seniors who are Medicaid eligible and looking for for assisted living and in-home care resources are the 1) Program for All-Inclusive Care for the Elderly (PACE) and 2) the Statewide Medicaid Managed Care Long-Term Care Program, which is operated under a home-and-community based Medicaid waiver from the federal government to provide options for seniors who otherwise would require nursing home care but want to stay in their own communities or even their own home.

Medicaid Waiver Programs for Assisted Living and In Home Care

Florida Statewide Medicaid Managed Care Long-term Care Program (SMMC LTC); or, Florida Long-Term Care Managed Care Medicaid Waiver

Most Florida Medicaid recipients are enrolled in the Statewide Medicaid Managed Care (SMMC) Program. TheAgency for Health Care Administration (ACHA) is responsible for administering the SMMC program and re-procuring health plans every five years. The SMMC program has two components, the Long-term Care (LTC) program and the Managed Medical Assistance (MMA) program.

Services

Services include: Adult companion services, adult day care, assistive care services, assisted living facility services, attendant care, behavior management, caregiver training, case management, home accessibility adaptation, home delivered meals, homemaker, hospice, intermittent and skilled nursing, medical equipment and supplies, medication administration, medication management, nursing facility care, nutritional assessment and risk reduction, occupational therapy, personal care, personal emergency response system (PERS), physical therapy, respiratory therapy, respite care, speech therapy, and transportation

Eligibility

  1. Health: Applicant’s must require a Nursing Home Level of Care and meet one or more established clinical criteria set by the Comprehensive Assessment and Review for Long-Term Care Services (CARES)
  2. Financial: An applicant for the SMMC LTC program must meet certain income and asset limits to be eligible for Medicaid for long-term care. Florida is a Special Income Limit (SIL) state, and allows waiver participants to be eligible if their monthly income is below $2,205 and their assets do not exceed $2,000 (or $3,000 for a couple). If an applicant’s income is too high, then a Miller Trust (also known as a Qualified Income Trust) can allow them to access the benefits by funneling their income into the trust for purposes of paying for care. For a non-applicant spouse, there are also asset and income limits. For 2017, the non-applicant spouse may keep up to $120,900 in assets and receive up to $3,022.50 per month for expenses without it affecting the eligibility of the applicant-spouse.

Practical Considerations

Florida’s single Medicaid waiver program for seniors wishing to use Medicaid benefits for long-term care outside of a nursing home facility caps its enrollment at around 35,000 applicants. Due to the large population of elderly persons and the state’s status as a Special Income Limit state with the ability to use a Miller Trust, it is likely possible that although an applicant may be eligible there will just never be enough space in the program to accommodate them. You can find information on enrollment in the SMMC LTC program and other Medicaid services here.

Conclusion

Florida provides numerous state resources for non-nursing home long-term care, and the SMMC LTC program for assisted living and in-home care is just one of the many options. Before applying for the waiver program, it is strongly recommended you work with a Medicaid Planning specialist to determine the feasibility of accessing the benefit, even if your income and assets are within the limit. If you decide that you would like to apply for the SMMC LTC medicaid waiver, then a Medicaid Planning specialist may help you qualify for benefits sooner by creating a strategy to meet the strict financial requirements for Medicaid for long-term care.