Approximately 88% of seniors and people with disabilities in Florida qualify for Medicaid, the national health coverage program that provides basic health care to low-income children, adults and seniors.
In Florida, Medicaid is administered by the Agency for Health Care Administration, a state-run agency. Seniors who already receive Supplemental Security Income are automatically enrolled in Medicaid, and they only need to file an additional application when requesting Medicaid-funded long-term care services.
Seniors who do not receive SSI benefits must meet strict income and asset limits to qualify for free Medicaid coverage. Income limits are currently set at $2,313 per month for an individual and $4,626 per month for a couple, which is 300% of the federal poverty level.
Medicaid applicants can own no more than $2,000 in countable assets ($3,000 per couple), however, there are some exclusions such as one vehicle, a non-revocable burial trust and a home owned and occupied by the applicant worth up to $585,000.
Statewide Medicaid Managed Care Long-Term Care Program
Established by the Florida government in 2011, the Statewide Medicaid Managed Care Long Term Care program reduces nursing home placement rates among Medicaid-covered seniors by funding long-term care services within assisted living facilities.
SMMC LTC enrollees are provided long-term care services based on medical necessity. Every assisted living facility that provides contracted SMMC LTC services must offer:
- Adult day health care
- Medication management and administration
- Personal emergency response systems for seniors
- Skilled nursing
- Attendant and personal care
- Transportation assistance
- Prepared meals
- Speech, occupational, physical and respiratory therapy
- Homemaker services
- Durable medical supplies and medical equipment
- Hospice care
- Behavior management
- Case management
To qualify for the SMMC LTC program, applicants must be eligible for free Medicaid coverage and either at least 65 years old or over the age of 18 and enrolled in Medicaid due to a disability. Seniors need to meet the Medicaid requirements for nursing home placement and be willing to reside in an assisted living setting with additional supports.
Applicants must also complete a preadmission screening program through the
Comprehensive Assessment and Review for Long-Term Care Services program. This federally-mandated screening program identifies seniors’ long-term care needs and recommends the least restrictive care services, which may include enrollment in the SMMC LTC.
For more information on Medicaid and the SMMC LTC or to request a CARES assessment, contact the
Pasco County Elder Helpline at (800) 861-8111.