Florida Medicaid’s PAC Waiver Changes
The 2017 Legislature amended the law to allow individuals who are diagnosed with AIDS to obtain and maintain Medicaid coverage without the need for enrollment in the PAC Waiver. This transition occurred on January 1, 2018.
In order to qualify for Florida Medicaid, an individual must meet the following criteria:
- Confirmed diagnosis of AIDS
- AIDS-related opportunistic infection
- Income at or below 222% of the federal poverty level (or 300% of the federal benefit rate)
- Assets that do not exceed $2,000 (individual) or $3,000 (couple)
- Hospital level of care
Most recipients previously enrolled in the PAC Waiver receive their medical, prescribed drugs, and acute care services from a Statewide Medicaid Managed Care - Managed Medical Assistance (MMA) health plan. There is no change in how these individuals receive MMA services unless they choose to change plans. With the advances that have been made over the last decade in the treatment of HIV and AIDS, the majority of the people who were on the PAC Waiver did not use or need the home and community-based services offered through the waiver. As such, the recipients in the PAC Waiver who were only receiving case management services, specialized medical equipment and supply services, and/or restorative massage services and did not need additional home and community-based services in order to safely remain in the community, were dis-enrolled from the PAC Waiver, but kept their Medicaid coverage. This means no loss in services – they can continue to have access to their medications, see their doctors, and receive case management from their current MMA plan.
The recipients in the PAC Waiver who were receiving more than case management services, specialized medical equipment and supply services, and/or restorative massage services through the PAC Waiver and who continued to need home and community-based services in order to live safely in the community transitioned into the Statewide Medicaid Managed Care Long-term Care (LTC) program for their home and community-based service needs. These recipients continue to maintain Medicaid eligibility and have access to their prescribed drugs and doctors through their current MMA plan. They also are continuing to receive home and community-based services, provided through an LTC plan. The Agency provided these individuals with an opportunity to choose an LTC plan that best met their needs. The LTC program offers a more robust benefit package than the PAC Waiver, including enhanced case management standards and expanded benefits. The LTC program also offers recipients an opportunity to receive care/services through a program with enhanced quality outcome measures.
Pre-Welcome Letters
PAC LTC - English
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139.4 kB
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PAC LTC - Spanish
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139.5 kB
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PAC LTC - Creole
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111.1 kB
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PAC MMA - English
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137.4 kB
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PAC MMA - Spanish
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137.8 kB
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PAC MMA - Creole
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20.4 kB
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Florida Medicaid Managed Care
The Long-term Care program welcome and reminder letters can be viewed at: https://www.flmedicaidmanagedcare.com/. Additionally, you can view brochures that provide additional information related to the Long-term Care program.
Webinar Dates
| Date | Time | Presentation |
|---|---|---|
| July 26, 2017 | 10:00 – 10:50 am, ET | July PAC Presentation [
769.8 kB
]
|
| August 15, 2017 | 2:00 - 3:00 pm, ET | August PAC Presentation [
750.7 kB
]
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| September 19, 2017 | 2:00 - 3:00 pm, ET | *Cancelled due to post Hurricane Irma recovery efforts |
| October 17, 2017 | 2:00 - 3:00 pm, ET | October PAC Presentation [
663.9 kB
]
|
| November 14, 2017 | 2:00 - 3:00 pm, ET | November PAC Presentation [
770.3 kB
]
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| December 12, 2017 | 2:00 - 3:00 pm, ET | December PAC Presentation [
661.2 kB
]
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| Post-Transition Stakeholder Webinar: PAC, ACF, TBI/SCI | ||
| January 23, 2018 | 2:00 – 3:00 pm, ET | January Post-Transition Presentation [
891.8 kB
]
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Individuals may also contact the Agency at 1-877-254-1055 if they have additional questions.
Waiver Services
The Agency conducted a review of the LTC program to ensure that it offers services consistent with those received through the PAC Waiver. Below is the PAC Waiver and LTC Services comparison.
PAC Waiver Services Crosswalk
| Current PAC Waiver Services |
Current PAC Waiver Procedure Codes |
SMMC Services |
SMMC Service Titles |
SMMC Procedure Code(s) |
Modifier 1 |
|---|---|---|---|---|---|
| Case Management | G9012 | LTC/MMA | Care Coordination/ Case Management | G9002 | |
| Chore – Other | S5120 | LTC | Homemaker | S5130 | |
| Chore – Pest Control | G9005 | LTC | Homemaker | G9004 G9005 |
|
| Day Health Care | S5100 | LTC | Adult Day Health Care | S5100 | |
| Education and Support | 95152 | LTC | Care Coordination/ Case Management | G9002 | |
| Environmental Accessibility Adaptations | S5165 | LTC | Home Accessibility | S5165 | |
| Home Delivered Meals | S5170 | LTC | Home Delivered Meals | S5170 | |
| Homemaker | S5130 | LTC | Homemaker | S5130 | |
| Personal Care | 99509 | LTC | Personal Care | T1019 | |
| Skilled Nursing (LPN) | T1003 | LTC | Intermittent and Skilled Nursing, LPN | T1003 | |
| Skilled Nursing (RN) | T1002 | LTC | Intermittent and Skilled Nursing, RN | T1002 | HN |
| Restorative Massage* | 97124 | MMA | Restorative Massage | 97124 | |
| Specialized Medical Equipment and Supplies | E1399 | LTC/MMA** | Medical Equipment and Supplies/ Durable Medical Equipment (DME) | E1399 S5199 |
AU |
| Specialized Personal Care for Foster Children | S5145 | MMA | Florida Medicaid covers children via the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, which provides comprehensive and preventive health care services for children under age 21. | ||
| Therapeutic Management of Substance Abuse | T1007 | MMA | Behavioral Health Services | H2020 H2019 |
|
* This is a historical code. Plans have the flexibility to determine the appropriate code(s) to use for a service. New service added for individuals where the service is medically necessary and have a diagnosis of AIDS.
** Expanded DME services are available to MMA recipients with a diagnosis of AIDS and who have had a history of an AIDS-related opportunistic infection.
