Statewide Medicaid Managed Care Long-Term Care Recipient FAQs
1. What is Medicaid long-term care?
The Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) program provides long-term care services to eligible persons 18 years and older who need long-term services and support.
Three state agencies work in tandem on the LTC program:
Agency for Health Care Administration:
- Maintains federal authority
- Makes rules and program policies
- Enroll recipients in health plans
- Holds Medicaid Fair Hearings (Medicaid services)
Department of Elder Affairs (DOEA):
- Conducts screening
- Prioritizes the LTC wait list
- Manages the wait list
- Determines medical eligibility for the LTC program
Department of Children and Families (DCF):
- Financial eligibility for Medicaid
- Holds Fair Hearings (screening results and eligibility)
2. Is the long-term care program like “regular Medicaid”?
No, the SMMC Long-Term Care program is not an entitlement program like Medicaid state plan (“regular Medicaid”) and does not include medical care, doctor visits or hospital stays.
3. What services does the long-term care program provide?
The LTC program provides the following home and community-based services to help individuals live in their homes or in a community setting. Learn more about the
Home And Community-Based Services Provided By The LTC Program
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- Adult Companion Care
- Adult Day Health Care
- Assistive Care
- Assisted Living
- Attendant Nursing Care
- Behavioral Management
- Caregiver Training
- Care Coordination/ Case Management
- Home Accessibility Adaptation
- Home Delivered Meals
- Homemaker
- Hospice
- Intermittent and Skilled Nursing
- Medical Equipment and Supplies
- Medication Administration
- Nutritional Assessment / Risk Reduction
- Nursing Facility
- Occupational Therapy
- Personal Care
- Personal Emergency Response System (PERS)
- Respite Care
- Physical Therapy
- Respiratory Therapy
- Speech Therapy
- Transportation to LTC Services
4. How are services delivered?
Program recipients receive their services through managed care organizations (health plans).
5. Am I eligible for the Florida Medicaid long-term care program?
Persons must be screened and assessed to find out if they are eligible to receive services through the LTC program. The Department of Elder Affairs (DOEA) uses the screening scores to prioritize individuals for placement on the wait list; releases persons from the waitlist as enrollment becomes available and conducts assessments of medical eligibility for Medicaid long-term care services. The Department of Children and Families (DCF) determines financial eligibility for Medicaid.
6. What are the steps I take to get LTC services?
Step 1: Screening-
Call your local Aging and Disability Resource Center (ADRC) for screening.
- The ADRC will ask you screening questions in a telephone call.
- Screening score and priority rank decide wait list placement.
Step 2: Eligibility-
If placed on the waitlist, you will be notified when enrollment is available.
- DOEA Comprehensive Assessment and Review for Long-Term Care Services (CARES) staff will assess your needs and decide if you meet medical eligibility.
- DCF will decide if you meet financial eligibility for Medicaid and send you a letter in the mail to tell you the outcome.
Step 3: Enrollment-
If you are approved for the LTC program, the Agency will send you a welcome packet with information on choosing a plan.
7. What is screening?
Space is limited for the in-home and community-based services in the LTC program. Before you can get these services, you have to speak with someone who will ask you questions about your health and activity needs. This is called a screening. The Department of Elder Affairs’ Aging and Disability Resource Centers (ADRCs) complete these screenings.
8. How are persons placed on the LTC waitlist?
Once the screening is complete, your name may go on a waitlist, depending on your screening score. This score determines the priority for being placed on the waitlist. Individuals with a low priority rank will not be placed on the waitlist. Individuals with a high priority rank will be placed on the waitlist to receive LTC services.
When you are released from the waitlist, the Department of Elder Affairs Comprehensive Assessment and Review for Long-term Care Services (CARES) program will ask you for more information about yourself to make sure you meet medical requirements to receive services from the LTC program.
9. What is an assessment?
The CARES program is required to review each person who requests Medicaid nursing facility services, or who wants to get home and community-based services through Medicaid waiver programs like the LTC program. CARES staff conduct this review, or assessment when enrollment in the LTC program is available.
A registered nurse and/or assessor does the assessments. A doctor or registered nurse reviews each application to decide the right level of care for the person. The assessment finds long-term care needs and suggests the right placement. CARES staff usually do the in-person visit in the individual’s home setting at no cost to the person.
10. What is a “level of care”?
To receive Medicaid LTC services, a person must meet medical requirements and be determined by CARES to require a nursing home level of care or hospital level of care for persons diagnosed with cystic fibrosis. This level of care is decided through the assessment.
The level of care is based on the person's medical condition, therapies, treatments, and services that the person is receiving on the date of the assessment. Levels of care vary from persons residing in or who must be placed in a nursing facility to persons at risk of being placed in a nursing facility. Persons at urgent risk of being placed in a nursing facility need constant availability of routine medical and nursing treatment and care, and have a limited need for, or require complex health-related care and services because of mental or physical illness. (See s. 409.983, Florida Statutes)
11. Who can I contact if I have general questions about LTC services?
Contact your local Aging and Disability Resource Center (ADRC) or call the statewide toll-free Elder Helpline at 1-800-96-ELDER (1-800-963-5337).
12. Who can I contact if I have questions about Medicaid eligibility?
Please contact the Department of Children and Families Public Benefits and Services.
13. Who can I contact if I am having issues with receiving long-term care services from my health plan?
Please contact the Medicaid helpline at 1-877-254-1055 to report those issues; or you may file an online complaint: Florida Medicaid Complaint Form.
Back: Make a Complaint or Ask for a Fair Hearing (about LTC Services)
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