Medicaid in Florida: Simplifying the State Long-Term Care Program

Medicaid in Florida: Simplifying the State Long-Term Care Program

Aging is an expensive adventure. If you envision your “golden years” spent indulging in grandchildren and travel, the time to make a financial plan is now. Probably before now, but better late than never! Conservative estimates from the investment group of Bank of America suggest that individuals who plan to retire at 65 should plan to have at least $1M in savings upon retirement. Healthcare spending rises as individuals age with nearly half of those costs occurring after age 65 (

A Financial Plan is a Must!

Poor or non-existent planning results in few options in later years. The idea that if one runs out of money, the State will foot the bill is not a solid plan. In Florida, funding of the Medicaid Program is tenuous at best each year, with the amount of contribution fluctuating each year and dedicated to programs serving residents of the state of Florida from 18 years of age to 100+.

AHCA Helps in the Medicaid ProcessDOEA Helps with the Medicaid Process

The Statewide Medicaid Managed Care Long-term Care Program does not guarantee eligibility or funding for all who apply. The Agency for Health Care Administration (AHCA) administers the program and sets coverage policy. They also assist in getting those eligible for services enrolled in an LTC plan. The Department of Children and Families (DCF) is responsible for determining financial eligibility for services. The Department of Elder Affairs is responsible for determining medical eligibility and the level of care needed.

 Three Steps to a Medicaid Application

  • Screening
  • Eligibility
  • Enrollment

Prior to the screening process, it must be determined if the individual meets the requirements for eligibility to apply to receive Long-term Care program services. This includes those who are:

  • Age 65 and over and eligible for Medicaid, or
  • Age 18 and over and eligible for Medicaid due to a disability; and
  • Determined by the CARES Program at the Department of Elder Affairs (DOEA) to be at a nursing home level of care or hospital level of care with cystic fibrosis.

The DOEA decides if an individual is medically eligible while the Department of Children and Families (DCF) determines financial eligibility for Medicaid. Once determined eligible, the individual can be screened.

Starting the Medicaid Process

Screening is completed by a local Aging and Disability Resource Center (ADRC). Screening consists of an initial phone call that results in a score used for placement on the waitlist to receive long-term care services. Individuals with a low score will not be placed on the waitlist and will be provided with information on community resources for assistance. Individuals with a high score will be notified that they have been placed on the waitlist.

  • Screening Exceptions:
    • An individual aged 18,19, or 20 who has a chronic debilitating disease that makes the individual dependent on 24-hour medical supervision or intervention
    • A nursing facility resident who requests a transition into the community and who has resided in a Florida-licensed skilled nursing facility for at least 60 consecutive days
    • An individual referred for temporary placement in an assisted living facility by DCF and is being funded by DCF
    • An adult with cystic fibrosis

Eligibility is determined by DCF and DOEA while the individual is on the waitlist. Release from the waitlist is not determined by how long an individual has been on the list, but rather by the score assigned and frailty-level ranking. When enrollment becomes available, the ADRC will contact the individual on the waitlist and begin the enrollment process.

The Comprehensive Assessment and Review for Long-Term Care Services (CARES) Program will assess each person who requests funding from Medicaid. The assessment will determine which level of care will best meet the individual’s needs. This is usually done in the person’s home setting.

Enrollment in Statewide Medicaid Managed Care

Enrollment in a Statewide Medicaid Managed Care program begins when a welcome letter and information about how to select a plan is received. The plans available in each region or county are available on the Statewide Medicaid Managed Care website. Once a program is chosen, enrollees have 120 days to change plans. Or an enrollee can wait to change plans during their once-a-year enrollment period with a State-approved good cause reason.

The process of applying for Medicaid can be overwhelming. The Statewide Medicaid Managed Care Long-term Care Program website is a great resource but there is no need to go through the process alone. Arm yourself with experienced professionals who can help you with a financial plan. Let them walk you through the steps from screening to enrollment. An elder law attorney is invaluable in executing a plan that is tailored to your goals and finances. The time to make that plan is today!


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