Florida’s Statewide Medicaid Managed Care Long-Term Care Program was established in 2013 and helps Medicaid eligible seniors in Florida receive senior care in their home, in their community, or at an assisted living community. If you or a senior loved one are currently receiving long term care in Florida, then it’s important to learn what Florida’s Statewide Medicaid Managed Care Long-Term Care Program (known as “SMMC LTC” for short) covers, who is eligible for SMMC LTC, and how to apply for coverage under SMMC LTC. While you should always consult an elder care specialist or attorney before making any long term care decisions for yourself or your senior loved one, the below guide should help give you a sense of whether SMMC LTC may be right for you.

What SMMC LTC covers

SMMC LTC provides access to a wide range of services and care options for eligible Florida seniors. Access to particular programs will vary for SMMC LTC participants, the full list of services includes: 

• Adult day health care
• Assistive care services
• Assisted living residence services
• Behavioral management
• Care Coordination / Case management
• Caregiver training
• Home accessibility adaptation
• Home-delivered meals
• Hospice
• Medical equipment and supplies
• Medication administration
• Medication management
• Nursing facility
• Nutritional assessment / risk reduction
• Personal emergency response system
• Respite care
• Occupational physical, respiratory, and speech therapies
• Non-emergency transportation

In addition to these services, SMMC LTC also provides access to several Participant Directed Options or PDO’s. For Florida Medicaid purposes, a Participant Directed Option is a service that the enrollee may “self-direct,” meaning that the participant is able to choose who provides their care service and how that service is provided. With a PDO, the participant has a greater degree of control over selecting who is providing care and how they are providing that care. The following services can be participant-directed under SMMC LTC.

Adult Companion Care

Adult Companion Care helps with basic tasks around the home such as light housekeeping and meal preparation. Adult Care Companions also provide care on trips outside the house, such as to parks or shopping.

Attendant Care

Attendant care is provided for longer periods of time (generally two hours or more each day) and is provided by a licensed nurse. Attendant care often includes help taking medicine.

Homemaker Services

Homemaker services provide basic help around the house with tasks such as meal preparation, cleaning, and laundry.

Intermittent and Skilled Nursing

Intermittent and skilled nursing is generally focused on providing short stints of medical care (under two hour visits) by licensed nurses. Intermittent and skilled nursing often involves routine procedures like giving injections or caring for wounds after surgery.

Personal Care

Personal care focuses on helping individuals with their daily tasks such as eating, bathing, getting dressed, or using the bathroom. Personal care workers will often also help with chores around the house, such as meal preparation or cleaning.

Who is eligible for SMMC LTC

In order to be eligible for coverage for services under SMMC LTC an application must meet four basic requirements, namely that they: (1) are a legal Florida resident; (2) are a minimum of 65 years old or under 65 and designated as disabled by the Social Security Administration; (3) need a Nursing Facility Level of Care; and (4) meet the financial requirements for Florida Medicaid. While it is probably fairly obvious whether you or your senior loved one qualify for the first two criteria, the second two require slightly more explanation.

Nursing Facility Level of Care

While Florida Medicaid uses the term Nursing Facility Level of Care, the term is slightly misleading as it isn’t necessary for the participant to require nursing or other skilled medical services in order to qualify. Rather, Florida uses an in-person examination to determine whether an individual needs assistance with two or more of the Activities of Daily Living (although the care must be determined to be medically necessary by a physician or registered nurse). The determination whether an applicant requires Nursing Facility Level of Care is made after an assessment conducted by the Department of Elder Affairs, which includes an interview with the participant and review of their medical history and current needs. 

Financial Requirements

The financial eligibility requirements for SMMC LTC include both an income and an assets component. As of 2023, the income limit for an individual applying is $2,742 per month and for couples the joint income limit is $5,484 per month. One wrinkle exists for married couples where only one individual is applying for SMMC LTC coverage called the monthly maintenance needs allowance. The monthly maintenance needs allowance allows the spouse who is applying for SMMC LTC coverage to transfer income to their non-applicant spouse to help them to pay to continue to live independently. In 2023, this monthly maintenance needs allowance cannot cause the non-applicant’s income to exceed $3,716. By making this transfer, the applicant spouse can reduce their own income, which may help them qualify for Medicaid through the SMCC LTC, and make sure that their non-applicant spouse does not need to be impoverished for their applicant spouse to get care.

In addition to this income limit, there is an asset limit of $2,000 for a single applicant and $3,000 for a married couple when both spouses are applying. As with the income limitation, where only one spouse is applying the non-applicant spouse can retain a portion of the couple’s joint assets (as of 2023 the limit is $148,620) in what is known as the community spouse resource allowance. One thing to keep in mind is that not all assets are counted towards this limit. Assets that generally count towards the limit include cash, stocks, bonds, and other investments including in real estate that isn’t your primary residence. Assets that are exempt from this limit include personal belongings and household furnishings and automobiles. The main exemption, however, is for one’s primary home. As of 2023, a home is exempt from the Florida Medicaid asset limitation as long as it is the individual’s primary residence, and their equity interest is less than $688,000.

How to apply for SMMC LTC coverage

If you or a senior loved one are thinking about applying for SMMC LTC coverage (or senior care coverage more generally), a great first step is always to speak to a local Florida elder law or financial planning expert. Once you’re satisfied that SMCC LTC coverage is right for you, the first step in the application process is generally a call to the Florida Aging and Disability Resource Center to request a screening for home or community based care and to then schedule a phone call with the senior’s primary caregiver or closest family member. This interview, which generally takes 1-2 weeks to schedule, typically lasts roughly 30-45 minutes and covers the senior’s basic biographical information as well as their ability to complete the Activities of Daily Living. 

Following the interview, the senior applicant will receive a prioritization decision letter telling them whether their care can begin immediately or whether they have been put on the waiting list. SMMC LTC can only provide care to a limited number of Floridians at once, and so it is possible that a senior may have to wait for a service depending on where in Florida they live. If the senior applicant has been approved for immediate care, their next step is to apply for formal Medicaid approval through Florida’s Department of Children and Family Services ACCESS System.

To learn more about how Sunbound can help make paying for senior living and senior care more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and senior care and is on a mission to make senior living and senior care more affordable for everyone.