Medicaid, the nationwide health protection program, provides 16% of Florida residents with basic health coverage using funds from the state and federal governments. Designed to provide health care to those who cannot afford private health insurance, about 88% of all seniors and people with disabilities in Florida qualify for free Medicaid.
In order to qualify for Florida Medicaid, seniors can earn no more than 300% of the federal poverty level, which is $2,313 per month ($4,626 for couples). Income from all sources must be included when calculating monthly income for Medicaid. Seniors who already receive Social Security Income benefits are prequalified for Medicaid coverage.
Seniors must also meet asset limits, currently set at $2,000 for an individual and $3,000 for a couple. Countable assets include cash, bank account balances, recreational and investment property and stocks and bonds. Some assets are exempt, such as a non-revocable burial trust, one vehicle owned by the applicant and a home that the applicant owns and lives in valued below $585,000.
Note: Florida is an income cap state; therefore, seniors deemed ineligible for Medicaid due to excess income cannot spend down their excess income on medical expenses to become eligible.
Statewide Medicaid Managed Care Long-Term Care Program
Medicaid enrollees who are either disabled or elderly (aged 65 or older) and meet the criteria for nursing home placement may qualify for the Statewide Medicaid Managed Care Long-Term Care Program.
Created in 2011 by the Florida Legislature, this Medicaid waiver program is designed to lower the rates of nursing home placement among Medicaid enrollees by augmenting their care with additional medical and nonmedical services delivered in an assisted living setting.
The SMMC LTC program assigns services to participants based on medical necessity as determined by the Florida Comprehensive Assessment and Review for Long-Term Care Services program. A designated CARES assessor evaluates each senior who requests Medicaid-funded long-term care services and makes placement recommendations based on current and future care needs.
Seniors who are accepted into the SMMC LTC may be provided with one or more of the following:
- A personal emergency response system
- Attendant or personal care
- Homemaker services
- Help traveling to and from medical appointments
- Assistance with medication management and administration
- Skilled and intermittent nursing
- Nutritional counseling
- Hospice care
To learn more about Medicaid enrollment and the SMMC LTC waiver program or to request a CARES assessment, contact the
Hernando County Elder Helpline at (800) 262-2243.