What Does Florida Long Term Care Medicaid Cover?

Older Floridians (or their families) usually come to me because they need help paying for home-health care, assisted living facility care, or skilled nursing home care (and they don’t want to have to spend down all of their assets on those services in order to qualify for Florida long-term care medicaid services). As a quick reminder, my elder law firm focuses on helping its clients in South Miami, Kendall, North Miami, Aventura, Hallandale, Hollywood, Davie, Plantation, Pembroke Pines, Brandon, and Tampa (and throughout Florida) get the government to pay for about 15-40 hours a week of home health care; or approximately $1,400.00 - $1,500 toward an ALF bill; or the lions share of a semi-private room in a nursing home.

After I'm done protecting their assets and qualifying my clients for Medicaid's long-term care benefits, they begin to realize and appreciate the additional bonus services that come with being qualified for Medicaid (that are not provided by Medicare). For example, it's nice when my clients, who are seeking home health care or ALF care, realize that they get a little extra cash in their bank account each month (because Medicaid will pay for their Medicare Part B premiums that are usually automatically deducted from their social security retirement income).

My elder law attorney / medicaid planning clients are further pleasantly surprised when they are enrolled in a Medicaid long-term care plan and find out that Florida LTC Medicaid covers so much more. The Florida Medicaid program that helps pay for home health care and ALF care is often referred to as the Florida "Medicaid Waiver" Program.

Benefits and Services Provided by Florida Long Term Care Medicaid

All Florida Medicaid long-term care plans cover an array of medically-necessary services, in addition to normal Medicaid health insurance services (such as doctors visits and most prescriptions) and in addition to the home health agency, ALF and nursing home bill payments. The full Statewide Medicaid Managed Care Long-Term Care Program Coverage Policy can be found at the link. On page four, you’ll find all the Home and Community Based Care services (also referred to as the Medicaid Waiver program benefits) that can be provided for those who do not yet need nursing home care. Some of the services that Florida Medicaid LTC must cover for those who wish to age at home but who need assistance are: 

Adult Companion Care: this is for non-medical care when needed to protect the health, safety and well being of LTC medicaid recipient. This includes help with common household chores, such as light housekeeping, laundry, and meal preparation. If someone is needed to administer medications, this can also be provided. As a corollary to this service, when a Florida long-term care medicaid enrollee has someone to assist with these duties, and THAT person is temporarily unavailable, these homemaker services can be obtained, on a short term basis, at no extra cost. 

In addition, short term respite care can be provided when the usual caretaker is in need of a break/vacation. Sometimes, a family caregiver has to work and so it would make sense to request a care plan that includes regular visits to an adult day care center.

‍Adult Day Care. Adult day care will be provided with meals included (when the Medicaid recipient is at the adult day care center during a meal time). Adult day care centers also provide medical screenings, routine blood pressure/diabetes maintenance checks and the provision of therapies (physical therapy, occupational therapy, speech therapy) that are part of the patient’s prescribed care plan. ‍

‍Accessibility Adaptation for the Home. Florida long-term care Medicaid will provide needed adaptations to the house (e.g. installing ramps, grab-bars, widening doorways, modification of bathroom facilities, installing specialized electric or plumbing equipment needed to accommodate medical equipment) that the Florida Medicaid long-term care enrollee needs to remain safely in the home.

Caregiver Training. Those who provide uncompensated care can obtain guidance, training (on treatment regimens and how to use durable medical equipment), companionship and supervision. 

‍Dental / Vision / Hearing Care.‍

Home-Delivered Meals. When a medicaid recipient cannot shop or prepare food without assistance, meals may be delivered to their home as part of their Medicaid care plan.‍

Medicare Premium / Co-Pay / Co-Insurance / Prescriptions. For those who need assistance paying for medical-related expenses, and do not want to wait (the Florida Medicaid Waiver program includes these benefits, but there is a waiting list), we also assist with qualifying our clients for the QMB - Qualified Medicare Beneficiary) program - further discussed at the link.

Personal Emergency Response System. If warranted, your long-term care Medicaid plan should also provide a “life-alert” style device that can call for help in case of an emergency.

‍Transportation. The provision of transportation to and from SMMC-LTC services and benefits will be provided if needed. 

Other Mimimum Covered Long-Term Care Program Services, include:

• home accessibility adaptations
• homemaker services
• medical equipment and supplies
• medication management
• nutritional assessment
• personal care / medication administration / adult companion care, attendant nursing care, care coordination (case management)
• respite care
• physical therapy, occupational therapy, respiratory therapy, speech therapy
• transportation (non-emergency)

Those enrolled in a Florida long-term care plan will be provided a one-page summary of the services authorized on their plan of care. Some long-term care plans offer additional services such as: provision of cell phone, emergency financial assistance, hearing evaluations and non-medical transportation.

What is Included in the Medicaid Waiver Care Plan?

The Medicaid waiver care plan, which you should be provided (if not request in writing) should include: the care plan's effective date, when it will be reviewed (every 90 days at least), the Medicaid recipient's personal goals, strengths and preferences.

The Medicaid managed care plan, provided by the plan's case worker assigned to the Florida Medicaid enrollee, will also include which medical services are needed routinely, how often, which medical providers are providing the services, who is naturally available to help with the Medicaid enrollee's care (e.g. family who live with Medicaid recipient or who live close by),and medication oversight strategies.

If in an ALF, the care plan will include services being provided by the ALF (how much and how often).

Finally, a statement indicating that the Medicaid recipient has the right to file a grievance, appeal and fair hearing if services (that they believe are necessary) have been denied, reduced, terminated or suspended by the Medicaid managed care plan.

How Can I obtain these Florida Long-Term Care Benefits Through Medicaid? 

If you or your loved one's assets are not currently under $2,000.00 and/or if their income is not currently below $2,349.00 (as of 2020), then it is imperative that you contact an experienced elder law attorney who focuses on Medicaid planning. We can show you how to legally and ethically protect your income and assets without having to wait five years, without having to sell your house, and without having to go broke first.

Call to schedule a consultation today.

More information about the Differences between Florida's Long-Term Care Medicaid Programs the Florida Statewide Medicaid Managed Long Term Care Program

Additional information on what Medicaid Long-Term Care covers in Florida can be found at: ‍http://elderaffairs.state.fl.us/doea/smmcltc.php

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