Florida Medicaid Long Term Managed Care Update
It’s hard to believe it’s been 5 years since the initial implementation of the Statewide Medicaid Managed Care Long Term Care program (SMMC LTC). For those of you not acquainted with the program, the LTC program provides nursing facility and home based services to adults who meet the nursing home level of care. The Agency for Health Care Administration has created a snapshot picture of the LTC services. You can check it out at http://ahca.myflorida.com/Medicaid/statewide_mc/pdf/LTC/SMMC_LTC_Snapshot.pdf.
In addition to the LTC program, Florida implemented the Statewide Medicaid Managed Care Medical Assistance program (SMMC MA). The snapshot picture of MA services is available at http://ahca.myflorida.com/Medicaid/statewide_mc/pdf/mma/SMMC_MMA_Snapshot.pdf.
To be eligible for SMMC LTC services the individual must meet the following requirements:
- Age 65 and over and eligible for Medicaid.
- Age 18 and over and eligible for Medicaid by reason of a disability.
- Be determined by CARES unit at the DOEA to be at nursing home level of care and meet one or more of the established criteria.
Take the time to review the list of services the managed care plans must provide. In my experience if you don’t ask for it, they don’t provide it. A few surprises the LTC program includes: Home Delivered Meals (Mom’s Meals), Personal Emergency Response Systems, and Home Accessibility Adaptations to name a few. Each SMMC LTC company must assign a case manager to an eligible enrolled client and an assessment and care plan must be completed. You will want to meet with the case manager to ensure you receive the necessary services and supplies.
HEADS UP! The Waiting List to be enrolled in the LTC Home and Community Based Services (HCBS) is greater than 43,000 individuals. (http://fcoa.org/waitlistreport_052016.pdf). If your client or loved one requires assisted living services or care in the home they may have to wait many years to be awarded a slot to receive services. You will want to ensure your loved one can pay privately from their income and assets until a slot is awarded. A few exceptions to the waiting list: loved one applies and receives Medicaid benefits while receiving rehabilitation in a nursing facility, they can then transition to Assisted Living or to home with care. In the event the individual is unsafe in their home you may call APS 1-800-962-2873 for an evaluation, if warranted they contact DOEA and a slot will be awarded.
While your loved one is on the waiting list be sure to notify the Aging and Disability Resource Center (ADRC) of any significant changes in their circumstances. A significant change is defined as a change in health, living situation, caregiver relationship, or damage to individual’s home, or loss of spouse or caregiver. Review the 701S form (http://elderaffairs.state.fl.us/doea/forms/701S_Screening_Form.pdf) prior to calling the ADRC to ensure you are prepared to answer the questions appropriately.
Effective November 1, 2015 all Assisted Living Facilities contracting the Medicaid Managed Care Plans must provide a “home-like” environment. A home-like environment includes providing residents the opportunity to eat on their own schedule, with basic kitchen utensils and food choices available 24/7. Residents also can have visitors whenever they wish, they get to control their daily schedule including their personal sleeping schedule, and have unlimited access to a telephone.
If you have a complaint regarding the Medicaid Managed Care programs the State of Florida wants to know about it. You can complain online at https://apps.ahca.myflorida.com/smmc_cirts/ or call 1.877.254.1055.